N6945020R0052_JL2_NASCC.xls

XLS spreadsheet 41 KB Posted

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NAS Corpus Christi and NOSC Harlingen MFSS
Solicitation number
N69450-20-R-0052
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FRONTPAGE

NAS CORPUS CHRISTI
GUEST SPONSORSHIP REQUEST
PLEASE CHECK THE APPROPRIATE BOXES TO INDICATE YOUR AFFILIATION TO THE BASEACTIVERESERVEDEPENDENTRETIREDCIVILIAN
SPONSOR: LAST NAME, FIRST NAME MI
TO: SECURITY OFFICER, NASCCDATES OF EVENTHOME NUMBER
TYPE OF FUNCTION:HOURS OF EVENT
CELL NUMBER
NUMBER OF GUESTS
LOCATION
WORK NUMBER:
NAMEFULL SSN #DRIVER LICENSE & STATE OF LICENSEDATE OF BIRTHHOME/CELL PHONE
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Guest sponsors are responsible for any abuse that may arise from the guest's use of their credentials to access this installation. You should feel confident that a guest will honor and use this privelege in a responsible manner. Please take the time to communicate all of the policies that you observe while on this installation with each guest. Please be advised that your guest sponsorship priveledges can be revoked if a guest is found in violation of base policies or federal statutes.
Sponsor's Signature X__________________________________________
SIGNATURE OF APPROVAL:
BY DIRECTION OF SECURITY OFFICER
X__________________________________________DATE:
FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE - Any misuse or unauthorized disclosure can result in both civil and criminal penalties. PRIVACY ACT STATEMENT AUTHORITY: Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act. PRINCIPAL PURPOSE: To record names, signatures, and Social Security Numbers for the purpose of validating the trustworthiness of

Individuals requesting access to Department of Defense (DoD) systems and information. NOTE: Records will be maintained in paper form. ROUTINE USES: None. DISCLOSURE : Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or prevent further processing of this request.

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