PHASE_II_Amendment_App_03_-_NCIC_CONSENT_FORM_-_DEC_2014.pdf

NCIC CONSENT FORM

National Crime Information Center (NCIC) Inquiry Authorization and Waiver

1. In accordance with Army Regulation 190-13 and 596th Transportation Brigade Policy, all persons requesting admittance to Military Ocean Terminal, Sunny Point or Concord will be subjected to an NCIC inquiry. This inquiry is a criminal background check utilizing the Federal Bureau of Investigation (FBI) criminal database.

2. Individuals who are determined to have been convicted of serious crimes (felonies, as determined by state statutes); or a pattern of criminal activity, which is determined to be prejudicial to good order and discipline on a military installation (as determined by the Provost Marshal, Senior Law Enforcement Official, or designated representative) will be denied access.

3. An NCIC inquiry will produce a complete criminal history background on the individual, which will be maintained on file at the Visitor’s Center, under the control of the installation Provost Marshal for one year. After one year, the documents will be destroyed. NCIC results will only be viewed by authorized MOTSU and MOTCO security personnel. The NCIC results of persons denied access to MOTCO will be not be maintained. Disclosure of information obtained through an NCIC inquiry is governed by the North Carolina State Bureau of Investigations and the FBI.

I (print full name; first, middle, last) , have read the information presented above and understand the contents. I specifically authorized and voluntarily consent to a National Crime Information Center background check conducted by the 596th Transportation Brigade Provost Marshal’s Office for the purpose of obtaining access to Military Ocean Terminal - Concord.

Signature of Requestor Race Date

Date of Birth Place of Birth Gender (City & State)

Social Security Number Address:

Company Name Telephone

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

Appendix 03