Solicitation_Attachment_5_-_Visitor_Request_Worksheet.pdf

145 SFS VISITOR'S REQUEST WORKSHEET

(THIS WORKSHEET IS SUBJECT TO THE PRIVACY ACT OF 1974)

INSTRUCTIONS1.

All information must be completed; Spell out First, Middle, and Last Names (no initials). Email worksheet to usaf.nc.145-aw.list.bdoc@mail.mil.

AUTHORITY: 10 U.S.C. 8013, DODI 1000.30, AFMAN 31-113, and AFI 33-332 PRINCIPLE PURPOSE(S): To conduct National Crime Information Center (NCIC) check, on non-DoD affiliated civilian visitors.

DISCLOSURE: Disclosure of requested information is voluntary. However, failure to provide information may result in access privileges being refused or withdrawn. The Privacy Act Statement will apply throughout the duration of the visitor's visit to the 145 AW Installation.

SECTION I: Ensure all blocks are complete.

2.1. DISTRIBUTION INSTRUCTIONS APPROVED and DENIED ON FITNESS CRITERIA.

1.3. COMPANY

Visitor's Information

1.4 VISITOR'S DESTINATION & PURPOSE FOR VISIT

1.5. NAME 1.6. SOCIAL SECURITY # 1.7. DL# & STATE

1.1. SPONSOR'S RANK/ NAME & DoD or SS NUMBER

(LAST, FIRST, MIDDLE)

1.2. SPONSOR'S PHONE NUMBER & UNIT

SECTION

II: To be completed, signed, and dated by Security Forces.

1.9. VETTING RESULTS1.8 DATES & TIMES VISIT 1.9.1 VETTED BY

Ensure all information is loaded into the Main Gate Database and completed worksheet is sent to the 145SFS/CC, 145SFS/SFM, originator, sponsor (if different than the originator), and usaf.nc.145-aw.list.bdoc@mail.mil.

2.2. INFORMATION NEEDED FOR DENIAL ON FITNESS CRITERIA AND/OR MISCELLANEOUS COMMENTS, I.E. MAY NOT DRIVE.

Ensure full name, company, and reason for denial is placed below and/or comments if needed: Date:

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INSTRUCTIONS FOR COMPLETING VISITOR REQUEST WORKSHEET

SECTION I TO BE COMPLETED BY SPONSOR:

Block 1.1. Enter the sponsor's Rank/Name and DoD or Social Security Number.

Block 1.2. Enter sponsor's contact number and unit.

Block 1.3. Enter company's name of visitor being sponsored, if applicable, and/or any additional comments.

Block 1.4. Enter the visitors allowed destination or destinations by sponsor and a brief description of the visitor's purpose for visit.

Block 1.5. Enter Full Last Name, Full First Name, and Full Middle Name (No Initials).

Block 1.6. Visitor's Social Security Number.

Block 1.7. Enter visitor's issued driver's license or state issued ID number and state of issue.

Block 1.8. Ensure to enter the requested dates and times of the visitor.

(Note: Contractors that will need access for more than 10 cumulative days will need to complete a Form 28.)

SECTION II: TO BE COMPLETED, SIGNED, AND DATED BY SFS:

Block 2.1. Ensure all information is loaded into the Main Gate Database and completed worksheet is sent to the 145SFS/CC, 145SFS/SFM, originator, sponsor (if different than the originator), and usaf.nc.145-aw.list.bdoc@mail.mil.

Block 1.9. Ensure personnel are vetted via NCIC or CJLEADS, if NCIC is unavailable. Vetting results will be annotated by

APPROVED or DENIED.

Block 1.9.1 SFS personnel conducting the vetting will place their initials in this block.

SECTION I.9. & 1.9.1: TO BE COMPLETED BY SFS:

This spreadsheet contains FOR OFFICIAL USE ONLY (FOUO) information which must be protected under the Freedom of Information Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a). Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties. Further distribution is prohibited without the approval of the author of this worksheet unless the recipient has a need to know in the performance of official duties. If you have received this worksheet in error, please notify the sender and delete all copies of this worksheet. This worksheet contains FOR OFFICIAL USE ONLY (FOUO) information which must be protected under the Freedom of Information Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a). Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties. Further distribution is prohibited without the approval of the author of this worksheet unless the recipient has a need to know in the performance of official duties. If you have received this worksheet in error, please notify the sender and delete all copies of this worksheet.

Page 2 of 2Current as of 26 Oct 16

Block 2.2. This section will be used to annotate the reason for the denial, if visitor is denied, and/or any other pass-on information on the visitor, i.e. may not drive due to invalid driver’s license etc.

(Note: SFS member conducting the vetting will need to sign and date the completed form, Section II, Block 2.2.)

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