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N6945018Q1712_AMAG.xls

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Sheet1

AMAG
Access Management System
This information will be entered into AMAG in preparation for your arrival - passes picked up at BLDG. 9.
"FOR OFFICIAL USE ONLY"
Last Name:First Name (no nicknames):Middle Name (mandatory):
Are you a US Citizen?Card Number
5425841 (leave # in here)
Company Name:Drivers License No:Telephone number
Home Address:
City:State:Zip Code:
NAVFAC SE CIVILIAN SPONSOR: Courtney Peterson
PHONE NUMBER: 904-542-8815
Purpose of Pass: N69450-18-Q-1712 Site Visit
Start Date:End Date:
***Maximum of 30 days
SIGNATURE:____________________________ DATE:_____________
***Typed name in Signature line will suffice***
Authority: 5 U.S.C. 522A, and Privacy Act of 1974
Principle Purpose: To readily identify all personnel via numerical system of records that list individuals who are
allowed to access the military reservation, known as Naval Air Station, Jacksonville in furtherance of the stations
mission; and to comply verify and update the stations authorized user list in support of administrative and security
measures.
Routine Uses: To numerically identify and account for persons aboard Naval Air Station Jacksonville, their
entrance, exit and authorized locations.
"For Official Use Only"
Revised: November 14, 2012

Sheet2

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