Installation Access Roster.pdf

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REQUEST FOR VISITOR TO OBTAIN UNESCORTED ACCESS TO BUCKLEY AIR FORCE BASE

PRIVACY ACT

AUTHORITY: Title 10, United States Code 8012 PURPOSE: To assist security personnel in establishing a fitness determination through the identity proofing and vetting process.

INTENDED USE: To be utilized by personnel requesting to obtain guest installation access pass for unescorted access to Buckley Air Force Base (BAFB) for 1-30 days or for special one time events.

DISCLOSURE: Disclosure of requested information is voluntary; however, failure to provide information may result in denial of request or the refusal by the 460th Security Forces Squadron, Installation Access Control Section to permit access to the installation.

INSTRUCTIONS

1. All information must be complete and in alphabetical order or the form will be denied. 2. Guest must present government/state ID in order to establish identity. 3. Sponsor must be registered in DBIDS prior to submitting form. 4. Must be submitted to Access Control Staff 72 hours prior to request.

SECTION I: SPONSOR INFORMATION

SECTION II: GUEST INFORMATION

GUEST NAME (Last, First MI)

DOB (MMDDYY)

DRIVERS LICENSE NUMBER

ST

ACCESS - YES/NO

SECTION III: TO BE COMPLETED BY 460TH SECURITY FORCES INSTALLATION ACCESS CONTROL STAFF

NCIC CHECK CONDUCTED ON

APPROVING OFFICIAL (Last, First MI)

SIGNATURE

BUCKLEY AFB FORM 128, 20160728; Prescribing Directive: BUCKLEYAFBI31-218 11.0.1.20130826.2.901444.899636