NASCC Electronic Guest Sponsorship.pdf

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Attached to
ALFWAL RUBBER REMOVAL & REPAINT RUNWAYS, (18/36 & 13/31) WALDRON OUTLYING AIRFIELD, CORPUS CHRISTI
Solicitation number
N6945025RSC07
Issued by

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The document is a Guest Sponsorship Request form for Naval Air Station Corpus Christi (NASCC). This privacy-sensitive form requires sponsors to provide detailed information about guests seeking base access, including full Social Security Number, driver's license details, date of birth, and contact information. The form emphasizes that guest sponsors are responsible for their guests' conduct and can have sponsorship privileges revoked if guests violate base policies or federal statutes. The processing time for a guest sponsorship request is three working days, and sponsors must communicate base policies to their guests. The form includes a Privacy Act Statement referencing Executive Order 10450 and other legal authorities for collecting and validating individual information for Department of Defense system access.

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ACTIVE RESERVE DEPENDENT RETIRED CIVILIAN

HOME NUMBER

CELL NUMBER

TO: SECURITY OFFICER, NASCC

SIGNATURE OF APPROVAL: Martin Wheeler

X__________________________________________

BY DIRECTION OF SECURITY OFFICER

DATE:

Guest sponsors are responsible for any abuse that may arise from the guest's use of their credentials to access this installation. The guest sponsorship request takes (3 )working days to process. You should feel confident that a guest will honor and use this privilege 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 privileges can be revoked if a guest is found in violation of base policies or federal statutes.

HOURS OF EVENT

HOME/CELL PHONEFULL SSN #

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.

NAS CORPUS CHRISTI

GUEST SPONSORSHIP REQUEST

Sponsor's Signature X__________________________________________

WORK NUMBER:

PLEASE CHECK THE APPROPRIATE BOXES TO

INDICATE YOUR AFFILIATION TO THE BASE

SPONSOR: LAST NAME, FIRST NAME M

NUMBER OF GUESTS

LOCATION

TYPE OF FUNCTION:

DATES OF EVENT

NAME

DRIVER LICENSE &

STATE OF LICENSE

DATE OF BIRTH

FRONTPAGE

HOME NUMBERRow1: ---
TYPE OF FUNCTIONRow1:
HOURS OF EVENTRow1:
HOURS OF EVENTRow1_2:
CELL NUMBERRow1:
LOCATIONRow1:
NUMBER OF GUESTSRow1:
WORK NUMBERRow1:
1:
FULL SSN 1:
DRIVER LICENSE STATE OF LICENSE1:
DATE OF BIRTH1:
HOMECELL PHONE1:
2:
FULL SSN 2:
DRIVER LICENSE STATE OF LICENSE2:
DATE OF BIRTH2:
HOMECELL PHONE2:
3:
FULL SSN 3:
DRIVER LICENSE STATE OF LICENSE3:
DATE OF BIRTH3:
HOMECELL PHONE3:
4:
FULL SSN 4:
DRIVER LICENSE STATE OF LICENSE4:
DATE OF BIRTH4:
HOMECELL PHONE4:
5:
FULL SSN 5:
DRIVER LICENSE STATE OF LICENSE5:
DATE OF BIRTH5:
HOMECELL PHONE5:
6:
FULL SSN 6:
DRIVER LICENSE STATE OF LICENSE6:
DATE OF BIRTH6:
HOMECELL PHONE6:
7:
FULL SSN 7:
DRIVER LICENSE STATE OF LICENSE7:
DATE OF BIRTH7:
HOMECELL PHONE7:
8:
FULL SSN 8:
DRIVER LICENSE STATE OF LICENSE8:
DATE OF BIRTH8:
HOMECELL PHONE8:
9:
FULL SSN 9:
DRIVER LICENSE STATE OF LICENSE9:
DATE OF BIRTH9:
HOMECELL PHONE9:
10:
FULL SSN 10:
DRIVER LICENSE STATE OF LICENSE10:
DATE OF BIRTH10:
HOMECELL PHONE10:
11:
FULL SSN 11:
DRIVER LICENSE STATE OF LICENSE11:
DATE OF BIRTH11:
HOMECELL PHONE11:
12:
FULL SSN 12:
DRIVER LICENSE STATE OF LICENSE12:
DATE OF BIRTH12:
HOMECELL PHONE12:
13:
FULL SSN 13:
DRIVER LICENSE STATE OF LICENSE13:
DATE OF BIRTH13:
HOMECELL PHONE13:
14:
FULL SSN 14:
DRIVER LICENSE STATE OF LICENSE14:
DATE OF BIRTH14:
HOMECELL PHONE14:
15:
FULL SSN 15:
DRIVER LICENSE STATE OF LICENSE15:
DATE OF BIRTH15:
HOMECELL PHONE15:
SPONSOR:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
START DATE:
END DATE:
DATE:

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