N6274219R1309_SVForm.pdf

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N ot ic e of

P ol ic y

C ha ng e fo r t he C on tra ct in g Pr oc es s o n

A nd er se n A ir Fo rc e

B as e.

1.

Th e fo llo w in g ha s b ee n up da te d/ ch an ge d to re fle ct c ur re nt p ro ce du re s t o ga in a cc es s o nt o A nd er se n

A ir

Fo rc e B as e, G ua m a.

A cc ep ta bl e Id en tit y Pr oo fin g Ite m s b.

R eq ui re d do cu m en ta tio n fo r H w or ke rs c.

R eq ui re d do cu m en ta tio n fo r H w or ke rs d.

R eq ui re d do cu m en ta tio n fo r F V

R e.

Pr oc es s f or W ee ke nd W or k

R eq ue st s/ A fte r N or m al B us in es s H ou rs f.

Su bm itt in g

C on tra ct s g.

A ff id av it Su bm is si on s

2.

A cc ep ta bl e Id en tit y Pr oo fin g It em s.

T hi s i s t he p ro ce ss o f p ro vi di ng su ff ic ie nt in fo rm at io n w he n at te m pt in g to e st ab lis h an id en tit y fo r p ur po se s o f i ns ta lla tio n ac ce ss . T he fo llo w in g ite m s c an b e us ed to v et o ne s p er so n:

a.

R ea lID A ct C om pl ia nt

D L/

ID

(C ur re nt b.

SS

N C ar d c.

B irt h

C er tif ic at e d.

Pe rm an en t R es id en t C ar d or a n A lie n

R eg is tra tio n

C ar d (F or m

I-

1) e.

U .S

.P as sp or t ( C ur re nt f.

G ua m

ID

/D

L (w ith a dd iti on al su pp or tin g do cu m en ta tio n) g.

M ay or

’s L et te r ( fo r p ro of o f r es id en cy /m us t b e no ta riz ed h.

C er tif ic at e of

U .S

. C iti ze ns hi p

(F or m N

-5 o r N

-5 i.

C er tif ic at e of N at ur al iz at io n (F or m

N -5 o r N -5 j.

U

.S . C iti ze n

ID

C ar d (F or m

I-

7)

N O

TE

: F or id en tit y pr oo fin g pu rp os es , t he a pp lic an t m us t s ub m it a ph ot o id en tif ic at io n do cu m en t w ith th ei r a pp lic at io n (i.

e.

G ua m

D L an d

SS

N

C ar d)

If th e ap pl ic at io n on ly su bm its a S

SN

C ar d or B irt h

C er tif ic at e, th e ap pl ic at io n w ill b e re vo ke d un til a v al id p ho to

ID

c an b e pr od uc ed

3.

R eq ui re d do cu m en ta tio n fo r H w or ke rs

Th is se ct io n ha s b ee n cr ea te d to p re ve nt co nf us io n as w el l a s c la rif ic at io n fo r t he

H w or ke rs p ro ce ss

A ll of th e ab ov e lis te d ite m s w ill be a cc ep ta bl e fo r b as e ac ce ss

Th e fo llo w in g ar e ad di tio na l i te m s n ee de d fo r b as e ac ce ss

(if ap pl ic ab le a.

V al id D ep ar tm en t o f L ab or

ID

C ar d/

Pa pe r T em p

ID

C ar d b.

M em be r h as a

C ur re nt

V

IS

A i.

If V

IS

A is e xp ire d;

a n ap pr ov ed F or m

I-

7A ii.

C ur re nt p rin to ut o r s ta m pe d

Fo rm

I-c.

St am pe d Fo rm I-w ith d at e an d in iti al s o f I m m ig ra tio ns

O ff ic er

D

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C op y of F or m

I-fo r r ec ei pt o f p ay m en t ii.

C op y of

F or m I-

7C sh ow in g ap pr ov ed st at us N

O

TE

Th is se ct io n is o nl y ap pl ic ab le to th os e w ho h av e th e fo llo w in g ite m s.

N ot e ve ry w or ke r is g oi ng to fa ll in to th is c at eg or y

(i.

e.

if th e m em be r h as a V

IS

A

, a ll

V

IS

A li st ed it em s p er ta in et c.

4.

R eq ui re d do cu m en ta tio n fo r H w or ke rs

In th e ev en t o f H w or ke rs w or ki ng o n th e in st al la tio n, th e fo llo w in g ite m s a re n ee de d fo r t ha t p er so n( s) a.

G ua m

D ep ar tm en t o f L ab or H

ID

C ar d/ Pa pe r T em p

ID

C ar d b.

SS

N c.

C op y of c ur re nt

P as sp or t d.

G ua m D

L (if a pp lic ab le

5.

R eq ui re d do cu m en ta tio n fo r

FV

R

Th is se ct io n is a pp lic ab le to th os e pe rs on ne l w ho a re n ot a U ni te d St at es

C iti ze n an d no t a p ar t o f t he U ni te d St at es

T er rit or ie s.

T he fo llo w in g ite m s a re ne ed ed fo r t ho se w ho fa ll in to th is c at eg or y:

a.

C ur re nt

P as sp or t b.

C op y of

F or m I-

/P as sp or t s ta m p c.

C ur re nt

V

IS

A i.

If e xp ire d;

a pp ro ve d

Fo rm

I-

7A ii.

A pp ro ve d an d re ce ip t F or m I-

7C iii

A pp ro ve d an d re ce ip t F or m I-d.

G ua m D

L (if a pp lic ab le

N O

TE

Th e

FV

R p ro ce ss is a le ng th y pr oc ed ur e.

T he ty pi ca l a pp ro va l t im ef ra m e fo r a

F V

R is b us in es s d ay s.

T he da y ap pr ov al p er io d be gi ns th e da y up on re ce ip t o f t he p ac ke t f ro m ve tti ng

A tta ch m en t-1

/D es ig na te d

C ou nt ry

L is td ep ic ts th e co un tri es th at re qu ire a dd iti on al ve tti ng

Th is p ro ce ss n ee ds to b e co nd uc te d

N

LT

m on th in a dv an ce pe r A F gu id an ce

6.

Pr oc es s f or

W ee ke nd

W or k R eq ue st /A ft er

N or m al

B us in es s H ou rs

Th e

Pa ss

ID

a nd

V C

C se ct io ns w ill n o lo ng er ta ke h an d w al ke d W

W R

Th e of fic ia l w ay to su bm it a W

W R is vi a em ai l t o th e V

C C o rg an iz at io n bo x.

T he W

W R n ee ds to b e su bm itt ed p rio r t o

W ed ne sd ay of th e w ee ke nd b ei ng re qu es te d.

F ai lu re to c om pl y w ill re su lt in W

W R b ei ng d en i e d.

A tta ch m en t-2

/W W

R is a te m pl at e to b e us ed fo r t he re qu es t.

N am es w ill b e lis te d in al ph ab et ic al o rd er b y tra ck in g nu m be r ( i.e . A

-Z fo r t ra ck in g nu m be r 0 1-

, A

-Z fo r t ra ck in g nu m be r 0 1-

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F ai lu re to p ro vi de n am es in th is fa sh io n w ill re su lt in re su bm is si on fr om th e

PO

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Th e em ai l a dd re ss fo r W

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C us .a f.m il

7.

Su bm itt in g

C on tr ac ts

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PO

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’s re sp on si bi lit y to e ns ur e th e in te gr ity o f t he p ac ka ge be in g su bm itt ed

Fa ili ng to p ro vi de a n ac cu ra te

/e rr or fr ee p ac ka ge w ill re su lt in re su bm is si on

Th e fo llo w in g ite m s a re tr en ds se en fr om su bm itt in g ag en ci es a.

M is si ng C on tra ct N um be r f ro m fr on t p ag e b.

M is si ng S ig na tu re s f ro m th e bo tto m

(M us t h av e tw

o) c.

W ro ng F or m at d.

M is si ng

D at es /T im es fr om w he n th e co nt ra ct is ta ki ng p la ce e.

M is sp el le d N am es o n

II

I L og (n o pe n/ in k ch an ge s a llo w ed f.

M is si ng

P

II

fo r v et tin g pr oc es s

N O

TE

C on tra ct s a re a pp ro ve d ba se d on w he n th ey a re re ce iv ed

En su re y ou r w or ke rs k no w th ei r tra ck in g nu m be r u po n ar riv al a t t he

P as s &

ID

se ct io n.

F ai lu re to p ro vi de a v al id tr ac ki ng n um be r w ill re su lt in b ei ng tu rn ed a w ay

A tta ch m en t-3

/C on tr ac t T em pl at e w ill b e us ed fo r a ll fu tu re co nt ra ct su bm is si on s.

8.

A ff id av it su bm is si on s.

O nc e th e af fid av it ha s b ee n si gn ed b y th e m em be r(

s) ; t hi s d oc um en t i s va lid da ys a fte r t he o rig in al si gn at ur e.

I f t he a ff id av it is p ro ce ss ed da ys o r m or e af te r t he or ig in al si gn at ur e, th e m em be r m ay be su bj ec t t o pe rm an en t b ar m en t f ro m th e in st al la tio n (if th e m em be r a ns w er ed

N O to a ny p or tio ns in

S ec tio n

C

9.

If th er e ar e an y qu es tio ns a bo ut th e ab ov e lis te d ch an ge s, pl ea se c on ta ct T

Sg t T im ot hy J.

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Th e re qu es t i sf or A nd er se n

A ir

Fo rc e B as e ac ce ss

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Th e re qu es t i nc lu de s t he fo llo w in g in di vi du al s.

(S ee A tta ch ed Lo g In fo rm at io

n) . I nd iv id ua ls lis te d on th e lo g w ill b e is su ed a p as s w ith th e ap pr op ria te d at es /ti m es li st ed a bo ve

3.

If yo u ha ve a ny q ue st io ns o r c on ce rn s, co nt ac t 1 em ai l.c om or

-1

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36 SFS / VCC Andersen AFB

Examples of III Logs

The only fields that need to be filled out are the Subject, DOB, and SSN

Format is key

◦ The Subject is Last Name, First Name

◦ The Subject’s should be A to Z

◦ The Date of Birth is YYYY-MM-DD (26 Feb 1988= 1988-02-26)

◦ The Social Security Number needs to be the full number

Don’t worry about how many personal you put on the form.

Even if its one person, Do Not change the format

Examples of incorrect III Logs

Do not fill in any of the other fields

Do not add anything to the document Only the Names, DOB, and SSN are needed

Format is key

◦ Keep the Subjects in alphabetical order

◦ Type the Subjects Last Name, First Name

◦ If They Have no SSN, Leave it Blank

◦ Do not give only the last 4 of their SSN

◦ Do not change the format of the dates

The Good

The Bad

Contact us at

• 366-5650/1/2/3

• 36sfs.vcc@us.af.mil

RN

REQUEST

TYPE

QH/QR

III REQUESTER

DATE OF

REQUEST

SUBJECT FBI DOB SSN

PUR

CODE C/

J/ F/ H/ D

SPECIFIC REASON FOR III

REQUEST LIST

ASSOCIATED

INVESTIGATION AND

INDICATE IF QUERY MADE

AT TIME OF ARREST

1 QH C MG-Base Access

2 QH C MG-Base Access

3 QH C MG-Base Access

4 QH C MG-Base Access

5 QH C MG-Base Access

6 QH C MG-Base Access

7 QH C MG-Base Access

8 QH C MG-Base Access

9 QH C MG-Base Access

10 QH C MG-Base Access

11 QH C MG-Base Access

12 QH C MG-Base Access

13 QH C MG-Base Access

14 QH C MG-Base Access

15 QH C MG-Base Access

16 QH C MG-Base Access

17 QH C MG-Base Access

18 QH C MG-Base Access

19 QH C MG-Base Access

20 QH C MG-Base Access

21 QH C MG-Base Access

22 QH C MG-Base Access

23 QH C MG-Base Access

24 QH C MG-Base Access

25 QH C MG-Base Access

26 QH C MG-Base Access

27 QH C MG-Base Access

28 QH C MG-Base Access

29 QH C MG-Base Access

30 QH C MG-Base Access

Revised on September 21, 2012 USAF Base Access Affidavit This data will be used to screen individuals who have or are seeking access to US Air Force installations or facilities controlled by the US Air Force. Please answer each question. Access will be denied if this questionnaire is incomplete or missing from the Contractor Access packet. This information will be used to generate state and federal criminal history records checks.

A. PERSONAL INFORMATION

1. NAME (PRINT LAST, FIRST, MIDDLE): __________________________________________________________2. EMAIL:________________________________

3. MAIDEN NAME OR ALIAS: _____________________________________________________________________________________________________

4. SEX: _____ 5. SSAN: _________________________________ 6. DATE OF BIRTH: _______________ 7. RACE: _____________________

8. HAIR COLOR: _______________ 9. EYE COLOR: _____________ 10. HEIGHT: ____________ 11. WEIGHT: _____________

12. DRIVERS LICENSE #: _______________________________ 13. STATE: ____________ 14. HOME AND CELL PHONE #: ____________________________

15. CURRENT AND ON-ISLAND RESIDENCE ADDRESS: _____________________________________________________________________

16. CITY: _________________________ 17. STATE: ________________ 18. ZIP CODE: ________________19. HOW MANY YEARS ON ISLAND? _____________

B. PLACE OF BIRTH

CITY: _____________________________ STATE: _________________ COUNTRY: ______________________ CITIZENSHIP: ________________________

C. CRIMINAL HISTORY (Circle YES/NO)

1. Have you ever been barred from entry/access to any military installation or facility? YES NO Date______________________ Installation________________________

2. Are you wanted by federal or civilian law enforcement authorities, regardless of offense or violation? YES NO (i.e., has a judge issued an order for your arrest?)

3. Have you ever been convicted of a firearms or explosives violation? YES NO

4. Have you ever been incarcerated for 12 months or longer? YES NO

5. Have you ever been convicted of espionage, sabotage, treason or terrorism, murder, assault, sexual assault, YES NO Armed assault or robbery, rape, child molestation, drug possession, or drug distribution?

D. IMMIGRATION/WORKING STATUS (attach copies of all documentation)

Circle appropriate answer, and provide proper numbers.

6. Do you have a VISA? YES NO VISA #________________________________________

A. What type of VISA? Immigration VISA Non-Immigration VISA

B. What VISA Classification? H2 W1 B1 Other_____

7. Do you have a Form I-551 (Resident Alien/Green Card)? YES NO I-551 #________________________________________

8. Do you have an I-94? YES NO I-94 # _________________________________________

9. Do you have an Employment Authorization Document YES NO EAD/WAC #___________________________________ or WAC?

10. Do you have other Immigration Documents? YES NO Document & # __________________________________ (If YES, list type of document and number)

NOTE TO APPLICANT: ATTESTATION

I attest to the fact that I have been briefed by my employer and understand the purpose for the background check. I understand the information on this form is being collected in accordance with 50 U.S.C., Section 797, and DoDD 5200.8 federal laws permitting the installation commander to limit access to the installation for security reasons and that this data will be used to screen personnel who have or are seeking access to US Air Force installations. I have voluntarily completed this “Form” and shall provide the Air Force a specimen of my fingerprints, if/when requested. I understand that by signing this application, I acknowledge that I have been made aware of and have reviewed that Air Force’s list of “disqualifying factors” above. I hereby give my consent and authorization for the Air Force to conduct any additional background screenings deemed necessary over the next 12 months, to include comparing/checking my fingerprints against local, state, and federal criminal databases. The information I have provided on this application is true, complete, and correct to the best of my knowledge and belief, and is provided in good faith. I understand that a knowing and willful false statement on this application can be punished by a fine or imprisonment or both. (18 U.S.C. Section 1001)

Applicant Signature: ________________________________________ Date: _______________________________

Office Name: ___________________________________________ Office Number: ______________________________

Processing Officer: __________________________________________