J-Form 3-NSF Deveselu Base Access Request Form.xlsx
XLSX spreadsheet 24 KB Posted
- Attached to
- Job Order Contract (JOC) for US Naval Support Facility, Romanian Military Base, Deveselu, Romania
- Solicitation number
- N3319123R9000
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Contractors- Rom Citizens
| CONTRACTORS - ROM CITIZENS | |||||||||||||||||||||
| No. | Surname | Given Name | Personal Numeric Code | Date of Birth DD-MMM-YYYY | Place of Birth | M/F | Citizenship (for double/ multiple citizenships) | Passport Number (for double/ multiple citizenships) | Romanian Identity Card serial number | Employer's complete name | Country of origin of the employer | Employer's contact data | Employer registration number from the Romanian National Office of Commerce Registry | Position | Purpose of the visit (type of work to be performed) | Place of performing the work on the Base | Registration Number of the individual's working contract | Period of performance of the individual's working contract | Approved Access Period DD-MMM-YYYY | Approved Access Period DD-MMM-YYYY | Comments |
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 |
| NOTE: | |
| * | Access requests must be submitted 10 Business days in advance (30 days trial period until MOD clears) |
| * | Visitors are not authorized to access any perimeter roads or any other areas on the Romanian base without prior authorization from the NSF Operation/Security. |
| * | No photography allowed on base unless a photo pass is aquired through the Security Officer. |
| **FOR OFFICIAL USE ONLY- PRIVACY SENSITIVE ANY MISUSE OR UNAUTHORIZED DISCLOSURE OF THIS INFORMATION MAY RESULT IN BOTH CRIMINAL AND CIVIL PENALTIES. |
Contractors - US Citizens
| US Contractors | |||||||||||||||||||||
| No. (For Official Use Only) | Surname | Given Name | Date of Birth DD-MMM-YYYY | Place of Birth | Gender | Citizenship (for double/ multiple citizenships) | Passport Number | Employer's complete name | Country of origin of the employer | Employer's contact data | Employer registration number from the Romanian Office of Commerce Registry | Position | Purpose of the visit (type of work to be performed) | Place of work on the base | Estimated date of Arrival DD-MMM-YYYY | Estimated date of departure DD-MMM-YYYY | Registration Number of the individual's working contract | Period of performance of the individual's working contract | Approved Access Start (For Official Use Only) DD-MMM-YYYY | Access Finish (For Official Use Only) DD-MMM-YYYY | Comments |
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 |
| NOTE: | |
| * | The request needs to be submitted 10 Business days before the access date. |
| * | Visitors are not authorized to access any perimeter roads or any other areas on the Romanian base without prior authorization from the NSF Operation/Security. |
| * | No photography allowed on base unless a photo pass is aquired through the Security Officer. |
Contractors EU-Non ROU citizens
| No. | Surname | Given Name | Date of Birth DD-MMM-YYYY | Place of Birth | Gender | Citizenship | ID Number / Serial Number of personal identity card / Passport Number | Employer's complete name | Country of origin of the employer | Employer's contact data | Employer registration number from the Romanian National Office of Commerce Registry | Position | Purpose of the visit (type of work to be performed) | Place of performing the work on the Base | Estimated Date of Arrival DD-MMM-YYYY | Estimated Date of departure DD-MMM-YYYY | Registration Number of the individual's working contract | Period of performance of the individual's working contract | Approved access period Start DD-MMM-YYYY | Approved access period Finish DD-MMM-YYYY | Comments |
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 |
| NOTE: | |
| * | Access requests must be submitted 30 days in advance (Pending NCIS name check) |
| * | Visitors are not authorized to access any perimeter roads or any other areas on the Romanian base without prior authorization from the NSF Operation/Security. |
| * | No photography allowed on base unless a photo pass is aquired through the Security Officer. |
| **FOR OFFICIAL USE ONLY- PRIVACY SENSITIVE ANY MISUSE OR UNAUTHORIZED DISCLOSURE OF THIS INFORMATION MAY RESULT IN BOTH CRIMINAL AND CIVIL PENALTIES. |
US Forces - DoD
| US FORCES - DOD CAC | ||||||||||||||
| No. | Given Name | Surname | Date of Birth dd/mm/yr | Place of Birth | Gender | Citizenship | Passport Number or DOD ID number (as applicable) | US Military Agency / Organization | Grade / Rank | Title / Position | General purpose of the visit | Estimated Date of Arrival dd-mmm-yyyy | Estimated Date of departure dd-mmm-yyyy | Comments |
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
| NOTE: | |
| * | The request needs to be submitted 10 Business days before the access date. |
| * | Visitors are not authorized to access any perimeter roads or any other areas on the Romanian base without prior authorization from the NSF Operation/Security. |
| * | No photography allowed on base unless a photo pass is aquired through the Security Officer. |
| **FOR OFFICIAL USE ONLY- PRIVACY SENSITIVE ANY MISUSE OR UNAUTHORIZED DISCLOSURE OF THIS INFORMATION MAY RESULT IN BOTH CRIMINAL AND CIVIL PENALTIES. |
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