SFS 30 - Site Visit Base Access.pdf

PDF 302 KB Posted

Attached to
Static Display Aerospace Vehicles Restoration Federal contract opportunity
Solicitation number
FA489724QC056
Issued by
Department of the Air Force Air Combat Command

About this file

This document is a MEMORANDUM FOR the 366 SFS S3OV requesting the issuance of a Base Access Pass (366 SFS Form 30) for a contracted individual. The key details are:

The individual is requesting unescorted entry onto the installation for a defined time period and dates, with specified duty hours and days required. The individual's full legal name, Social Security number, driver's license or passport information, contract number, and sponsor information are provided. A background and local files check will be conducted. If approved, the 366 SFS/S3OV will authenticate the request. The Privacy Act Statement outlines the authority, purpose, and disclosure requirements for providing this information.

The related federal contract opportunity is for Solicitation FA489724QC056 for restoration and maintenance services for the USAF Airman Heritage Training Complex. This is a requirement of the Department of the Air Force Air Combat Command.

View the file

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Text version

b

CONTROLLED UNCLASSIFIED INFORMATION

MEMORANDUM FOR 366 SFS S3OV

FROM:

SUBJECT: Request for Installation Entry Pass (366 SFS Form 30)

1. The following individual is requesting issuance of a Base Access Pass for the reason / time period listed.

This letter is submitted IAW the 366 FW/Installation Defense Instruction.

TYPE OR FILL OUT LEGIBLY OR APPLICATION WILL NOT BE PROCESSED

APPLICATION MUST BE FILED TWO WEEKS IN ADVANCE OF NEEDING BASE ACCESS

1. FULL LEGAL NAME ( FIRST, MIDDLE , LAST)

3. SSAN 4. DATE OF BIRTH (YYYY/MM/DD)

5. D/L NUMBER (OR PASSPORT NUMBER) 6. STATE 7. CONTRACT NO. REQ'D FOR 1 YEAR PASSES

8. CONTRACT DATES / DATES OF VISIT 9. DUTY HOURS 10. DAYS REQUIRED (i.e. M/W/F)

Su M Tu W Th F Sa

11. EMPLOYED BY AND SPONSORS NAME & EMAIL ADDRESS 12. ON BASE SPONSOR PHONE #

2. Does the contractor require access to classified material: NO YES

3. Individual listed has been informed that a background and local files check will be conducted. The individual has been informed that disclosure of the above information is voluntary; however, failure to do so could result in the individual being denied access to the installation.

1st Ind, 366 SF /S3OV

MEMORANDUM FOR:

Approved/Disapproved

I

A

S

L

X

Authenticated on by

(Date)

(Signature)

(Printed name & grade) 366 SFS/S3OV

PRIVACY ACT STATEMENT: Authority: 50 U.S.C 797 and DOD Directive 5400 B

PRINCIPAL PURPOSES: To identify personnel requesting unescorted entry on to MHAFB who are Official Business Guests/

Students/Visitors/Houseguests/Designated Agents/MHSD Employees/FW-CC Sponsored Guests. ROUTINE USES: Information will be used to conduct a wants and warrants, criminal history check through the Air Force Law Enforcement Terminal System (AFLETS) and the local files check at the security police reports and analysis section (366 FW/A7SR).

DISCLOSURE IS VOLUNTARY: Failure to provide the information could result in the individual being denied base access. This letter of request will be sent to 366 SFS S3OV two weeks prior to the date the individual concerned requires the pass. 366 SFS FORM 30, Dec 2012

DISPOSITION: This document is for official use only once completed; if this document is no longer in use shred it for protection of the contents.

CONTROLLED UNCLASSIFIED INFORMATION

Male / Female

Text1:
Text2:
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Group12: Off
Text15: Printed Name & Signature of Sponsor

366 CONS /Duty Title/ Phone#

Group13: Choice1
Check Box16: Off
Check Box17: Off
Check Box18: Off
Check Box19: Off
Check Box20: Off
Check Box21: Yes
Check Box22: Off

File details come from the government source that posted it. Updated .