Attachment (9) REQUEST FOR C BADGE 2020 Rev D.pdf

A STANDARD ADVANCE NOTICE OF ONE WEEK IS REQUIRED, ALTHOUGH BONIFIED EMERGENCIES WILL BE CONSIDERED ON A CASE, BY CASE BASIS. Requests for weekend, non-standard duty hours and access to restricted areas (i.e. the naval magazine or supply) require special consideration and longer processing times. Please take this into consideration when making your requests. Revision (D) - 06 AUG 2020

FOR OFFICIAL USE ONLY

Privacy Act Statement: Pursuant to 5 U.S.C. section 552 and SECNAVINST 5720.42F, this information being requested is on a voluntary basis; however, failure to provide the personal information requested is grounds to deny you entry onto Naval Base Guam property, in accordance with DODINST 2000.16.

REQUEST FOR C BADGE

NOTE: CAC/DBIDS ARE REQUIRED WHEN USING C BADGE. CHECK THE APPROPRIATE BOX

CAC expiration date: DBIDS expiration date:

APPLICANT’S ORGANIZATIONAL INFORMATION

COMMAND NAME:

ACCESS REQUEST

ONE-DAY REQUEST: NAVAL MAGAZINE:

NAME POSITION

KILO WHARF:

MAILING ADDRESS:

DESCRIPTION OF WORK

BEING PERFORMED:

POINT OF CONTACT:

AUTHORIZATION

AUTHORIZING SPONSOR OR AGENCY POINT OF CONTACT:

POINT OF CONTACT PHONE NUMBER:

POINT OF CONTACT EMAIL ADDRESS:

EXPIRATION DATE (FILLED OUT BY APPROVER):

DATE AUTHORIZED (FILLED OUT BY APPROVER):

TYPE OF ACCESS GRANTED (FILLED OUT BY APPROVER):

SPECIAL ACCESS (FILLED OUT BY APPROVER):

ISSUED TO:

ISSUED BY: ISSUED DATE:

PERSONNEL INFORMATION

Command / Company

C-BADGE #DATE OF REQUEST: