FN Sec Access Form JUL 2024.pdf
PDF 127 KB Posted
- Attached to
- Barkley Powerhouse Replace HVAC, Zone 3
- Solicitation number
- W912P524Q0045
About this file
This document is a Foreign National Security Form from the Nashville District Corps of Engineers. It details the required information and documentation for non-U.S. citizens, including permanent residents, to obtain access to a U.S. Army Corps of Engineers project site or facility. Key details include:
The form must be submitted 30 days in advance and includes providing personal information such as full name, date of birth, citizenship, passport/visa details, and the work to be performed. Documentation is required to verify legal admission to the U.S. and employment/immigrant visa status. Non-U.S. citizens who have lived in the U.S. for at least 3 years also need a favorable background investigation per Homeland Security Presidential Directive 12 (HSPD-12). The information provided will not be retained after the scheduled site visit. Access is subject to approval by the Nashville District Security Office and notification to the contractor.
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Text version
COMPANY NAME / ADDRESS / MAIN PHONE #
Nashville District Corps of Engineers Foreign National Security Form
PRIVACY ACT STATEMENT
AUTHORITY: Information is solicited pursuant to Title 10, U.S. Code, Section 3013 and E.O. 9397 PRINCIPAL PURPOSE: To provide information necessary for preparation of a scheduled tour of the facility, verify positive identification of visitor(s), and conduct background checks for determinations of the eligibility of access to U.S. Army Corps of Engineers.
ROUTINE USES: Used by the U.S. Army Corps of Engineers to accompany a request for a scheduled tour of the facility.
MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT OF NOT PROVIDING INFORMATION: Providing the solicited information, including Passport or Visa Number, is voluntary; however, failure to provide information may result in a denial of visitor access due to an inability to verify identification. The information provided to the U.S. Army Corps of Engineers will not be retained digitally or by hard copy after the scheduled visit.
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: ___________________________________
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).
https://travel.state.gov/content/travel/en/us-visas/tourism-visit/visa-waiver-program.html
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
July 2024 mailto:tracy.dorrough@usace.army.mil mailto:jason.j.klinger@usace.army.mil
| COMPANY NAME ADDRESS MAIN PHONE: |
| FULL Name: |
| Date of Birth mmddyyyy: |
| Citizenship Country: |
| Passport Include copy scanned in color: |
| Visa Include copy scanned in color if applicable: |
| Work to be performed eg 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: |
| Primary Company POC NamePhone: |
| Primary Company POC Email Address: |
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