Foreign National Secuirty Form.pdf

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