PHASE_II__Amendment_App_02_-_Access_Request_MOTCO_FORM_190-3_DEC_2014.pdf

Last Name

First Name

Middle Name DOB DL # DL State Access from Access thru

US

Citizen

(Example) Schmidt John Jacob Jingleheimer* 1-Apr-85 B12594530 CA 20-Feb-12 31-Dec-12 Yes or No

Once the form is completed please email the form to: usarmy.motco.sddc.list.passandid@mail.mil

MOTCO FORM 190-3-R (PM)

DEC 2014

MOTCO Access Request

Company Name Reason for Access

Sponsor

Requesting Company's Name Reason for Access to MOTCO A MOTCO Common Access Card (CAC) holder's employee name and phone number

This form must be submitted a "MINIMUM" of 72 hours prior to access

* Enter "NMN" when there is no middle name.

Appendix 02

US State: Abbreviation: Commonwealth/Territory: Abbreviation:

Alabama AL American Samoa AS Alaska AK District of Columbia DC Arizona AZ Federated States of Micronesia FM

Arkansas AR Guam GU California CA Marshall Islands MH Colorado CO Northern Mariana Islands MP

Connecticut CT Palau PW Delaware DE Puerto Rico PR

Florida FL Virgin Islands VI Georgia GA Hawaii HI Idaho ID Illinois IL Indiana IN

Iowa IA Kansas KS

Kentucky KY Louisiana LA

Maine ME Maryland MD

Massachusetts MA Michigan MI

Minnesota MN Mississippi MS Missouri MO Montana MT Nebraska NE Nevada NV

New Hampshire NH New Jersey NJ New Mexico NM New York NY

North Carolina NC North Dakota ND

Ohio OH Oklahoma OK

Oregon OR Pennsylvania PA Rhode Island RI

South Carolina SC South Dakota SD Tennessee TN

Texas TX Utah UT

Vermont VT Virginia VA

Washington WA West Virginia WV

Wisconsin WI Wyoming WY

Please fill out all columns for any personnel you wish to gain access to the installation to include:

1. Full Last Name

2. Full First Name (do not shorten names or use nicknames, Mike or Mickey, if official name is Michael)

3. Full Middle Name (do not send just an initial, if no middle name, use NMN)

4. DOB (date of birth, please use format already on form, date should read DD

MMM YY)

5. Driver License Number

6. Driver License State of Issue (TX, MO, CA, second tab on form has all correct state/territory abbreviations)

7. Access From

8. Access Thru

When do your personnel require access? MOTCO will grant 1 year of access at a time, 1 year should read as such 5 Feb 13 through 4 Feb 14 (and again, please do not change date format, it should also read DD MMM YY as shown in example).

Obviously for personnel that are assigned here to MOTCO or to the new Reserve Center, we do not need an end date, but still require 71 hours notice for vetting.

If you need more lines than are on the sheet, it's a Excel spreadsheet, simply insert more.

Access requests must be received no later than 72 hours prior to when access is needed to ensure proper vetting can be completed. Please let me know if you have any further questions or require any assistance in completing the form.

Appendix 02