Tab 29 - 1818 Pre-enrollment sample.pdf

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Trailer Repairs at DLA Susquehanna, PA
Solicitation number
SP330023Q0117
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PRIVACY ACT STATEMENT

VISIT NOTIFICATION

1. ACTIVITY TO BE VISITED

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:DEFENSE LOGISTICS AGENCY

8725 JOHN J. KINGMAN ROAD

FT BELVOIR, VA 22060-6220

Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.

To control access to and movement on DoD installations, buildings, or facilities.

Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.

Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.

DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES

SECTION I

2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE

5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE

8. PURPOSE OF VISIT

SECTION II

9.

NAME(S) OF VISITOR(S)

(Last, First, MI)

10.

GRADE/RANK

11.

SSN

12.

DATE OF BIRTH

13.

STATE /COUNTRY OF

BIRTH

14.

CLEARANCE/DATE

GRANTED

15.

TYPE OF INVESTIGATION/

DATE

16. TYPED NAME OF SECURITY REPRESENTATIVE

SECTION III

18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE

DLA FORM 1818, JUL 96 (EG)

FROM: TO:

PDF (DLA)

RequesterName: John Doe
OfficeCode: D, DD, DM, DF, ect
FacPOC: John Doe
Phone: 717-770-xxxx
POCPhone: 717-770-xxxx
VisitedActivity: HR, CDC, FWMR, ect..
VisitPurpose: List purpose of visit; Interview, medical, meeting, etc..

Visitor has registered utilizing the pre-enrollment website: https://dbids-global.dmdc.mil/enroll

DateTo: 2 Jan 23
Visitor:
0: Doe, John M.
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GradeRank:
0: DVXTFG
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SSN:
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DOB:
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DateFrom: 1 Jan 23
SecRepName:
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ActPhone:
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tcsControl:
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ResetMe:
resetBtn:

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