Police records check.pdf
PDF 121 KB Posted
- Attached to
- AATTC Trailer Reconfiguration Federal contract opportunity
- Solicitation number
- W50S7G26RA005
- Issued by
- Department of the Army National Guard
About this file
This document is a 139 SFS Base Access Form for a Police Record Check, designed to facilitate visitor or contractor access to a military base. The form requires comprehensive personal information including name, social security number, date of birth, citizenship, drivers license details, and company affiliation. The Police Services Section includes a series of critical screening questions regarding citizenship, state-issued identification, active warrants, protection orders, FBI watchlist status, ongoing criminal charges, and disqualifying criminal record files. The form mandates submission to a specific email address at least 5 business days before the requested base access date, with a note that the information is protected as Criminal Justice Information (CJI) and subject to privacy regulations. Visitors must provide a signature authorizing information release and attesting to the accuracy of their provided details.
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Text version
POLICE RECORD CHECK
SPONSOR INFORMATION
Name: _______ _____________________ _____________________________ _________________ Rank First Last Unit of Assignment
DOD ID Number: ______________________ Contact Number: ________________________________________ *Submit completed forms to 139.AW.SFS.Registration.Section@us.af.mil a minimum of 5 business days prior to date of base access.
POLICE SERVICES SECTION
Information contained in this section is protected as Criminal Justice Information (CJI) and cannot be released outside of the SF Chain of Command. Unauthorized use or disclosure is in violation of Missouri Statute 576.050.
1. Is the individual a U.S. Citizen (for Non-U.S. Citizens forward a copy of the PRC to S5 Branch Chief)? _____
2. Does subject have a valid state issued license (valid state issued ID is required for base access)? _____
3. Does subject have any active warrants (If yes and member is present, conduct a hit confirmation)? _____
4. Does subject have any active protection orders? _____
5. Is the member identified as being on the FBI TSC Watchlist? _____
6. Does Subject have ongoing criminal charges or current court ordered admin actions (if yes, list below)? _____
7. IAW w/Wing policy, does subject have a disqualifying criminal record file (if so, list below)? _____
Operator: _______ _____________________ _____________________________ ______________ Rank First Last Date of Transaction *For derogatory base access determinations, contact the SF Operations Superintendent or higher competent authority.
This document may contain information or attachments which must be protected IAW AFI 33-332 and DoD Regulation 5400.11. The Privacy Act of 1974 (as amended) applies, and this document and any attachments thereto are Controlled Unclassified Information (CUI).
Information from this document or any attachments thereto must not be introduced into another system of records unless that system of records is described in the Federal Register IAW AFI 37-120.
139 SFS BASE ACCESS FORM, 20220222, V2
VISITOR/CONTRACTOR INFORMATION
Date of Base Access: ______________________ Date Form Completed: ______________________________
Name: ________________________ _________________________ ______________________________ First Middle Last
Social Security Number: ________________________________ Date of Birth: _______________________
Country of Citizenship: _____________ Sex: __________ Race: __________
Drivers License #: _______________________ State of Issue: __________ DL Exp Date: ____________
Company/Organization: ______________________________________________________________________
Project/Purpose for access: ____________________________________________________________________
Have you ever been barred from a federal installation or military base? ____ YES ____ NO
Visitor Signature: _________________________________________ *Signature above authorizes consent to release information and attests provided information is accurate/factual.
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