FN Contractor Security Access Form.pdf
PDF 89 KB Posted
- Attached to
- Pre-Solicitation for W912P525RA001 Chickamauga Lock Replacement Approach Wall and Decommissioning
- Solicitation number
- W912P525RA001
About this file
This is a Foreign National Security Form from the Nashville District Corps of Engineers that must be completed by all non-U.S. citizens, including permanent residents, who work on Nashville District (LRN) contracts or task orders. The form requires approval from the HQUSACE Foreign Disclosure Officer 30 days before beginning any contract work.
The form collects detailed personal information including full name, date of birth, citizenship, passport number, visa information (if applicable), work to be performed, work location, dates of access needed, job title, payment method, and company POC details. Additional requirements include documentation proving legal admission to the U.S. and employment/immigrant visa status (unless from a Visa Waiver Program country). Non-U.S. citizens who have lived in the U.S. for at least three years must also obtain a favorable background investigation per HSPD-12. The form is associated with the Chickamauga Lock Replacement Approach Wall and Decommissioning Project in Chattanooga, TN, and must be submitted for any foreign nationals planning to attend the pre-proposal site visit scheduled for February 20, 2025.
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Text version
COMPANY NAME / ADDRESS / MAIN PHONE #
Nashville District Corps of Engineers Foreign National Security Form
All non-U.S. Citizens, including permanent residents who work on Nashville District (LRN) contracts or task orders must be approved by the Headquarters U.S. Army Corps of Engineers (HQUSACE) Foreign Disclosure Officer before beginning any contract/task order work. Must be submitted 30 days in advance.
NOTE: At no time will a Contractor or Subcontractor be permitted to access the site until approved by the Nashville District Security Office and the Contractor Official has been notified.
FULL Name_______________________________________________________________________ (Last, First Middle)
• If you have only initials in your name, use them and state (IO). If you have no middle name, enter “NMN”
• If you are a “Jr.,”Sr.,” “II,” etc., you must include this
Date of Birth (mm/dd/yyyy): _________________ Citizenship (Country): ______________________
Passport # (Include copy scanned in color): _____________________________________________
Visa # (Include copy scanned in color if applicable): _______________________________________
* Visa information must be included unless country of citizenship is in the Visa Waiver Program
Work to be performed: (e.g. Plumbing, electrical) ________________________________________
Corps of Engineers Location (Project Office/ Work Site) Where Work is to be performed:
From & To Dates for Requested Site Access: ____________________________________________
Expected Arrival Date: ___________________ Job Title: ___________________________________
Method of Payment (U.S. Dollars, Euros etc.): ___________________________________________
Primary Company POC Name/Phone: _________________________________________________
Primary Company POC Email Address: _______________________________________________
In addition to the information above, the Contractor shall furnish documentation to verify he/she was legally admitted into the United States and has an employment or immigrant Visa (unless in the Visa Waiver Program). This includes, individuals living and working in the United States but are not U.S.
Citizens, such as permanent residents.
In addition to the requirements above, all non-U.S. Citizens who have lived in the United States for at least three years must also have or obtain a favorable background investigation in accordance with Homeland Security Presidential Directive 12 (HSPD-12) (guidance provided separately).
Nashville District Corps of Engineers Security Office Contact Information:
*Tracy Dorrough, Security Technician, 615-73-7397 email: tracy.dorrough@usace.army.mil Jay Klinger, Security Specialist, 615-736-2185 email: jason.j.klinger@usace.army.mil
* Primary - Personnel Security Investigations
March 2024 https://travel.state.gov/content/travel/en/us-visas/tourism-visit/visa-waiver-program.html mailto:tracy.dorrough@usace.army.mil mailto:jason.j.klinger@usace.army.mil
| COMPANY NAME ADDRESS MAIN PHONE: |
| FULL Name: |
| Visa Include copy scanned in color if applicable: |
| Corps of Engineers Location Project Office Work Site Where Work is to be performed: |
| Expected Arrival Date: |
| Job Title: |
| Method of Payment US Dollars Euros etc: |
| Primary Company POC Email Address: |
| Birthday format mm/dd/yyyy: |
| Country of Citizenship: |
| Passport Number: |
| What is your job?: |
| Begining and End dates for Site Access: |
| Primary Company POC Name Phone: |
File details come from the government source that posted it. Updated .