Form_5000-E_NCIC-III_Request_19Mar2015.xlsx

XLSX spreadsheet 12 KB Posted Dec 2, 2015

Attached to: Industry Day, Environmental Services, White Sands Missile Range
Solicitation number: W9124Q-16-R-ENVI
Issued by: Department of the Army Materiel Command Mission and Installation Contracting Command White Sands Missile Range

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From the source

Form 5000 - Please call me with this information unless you can encrypt it.

File	Type	Posted
One_on_One_Final_Q A_5Feb16_.docx	DOCX document	Feb 17, 2016
PWS_DRAFT_WSTC_Env_Services_01_Dec_2015.docx	DOCX document	Dec 9, 2015
ENV_Tentative_Agenda1_9Dec2015.docx	DOCX document	Dec 9, 2015
Environmental_Industry_Day_PowerPoint_8Dec15.pdf	PDF	Dec 9, 2015
Test_Center_Environmental_Services_Industry_Day_12162015_VER2.pdf	PDF	Dec 9, 2015
Draft_ENV_Tentative_Agenda_Oct_2015.docx	DOCX document	Dec 2, 2015
PWS_DRAFT_WSTC_Env_Services_01_Dec_2015.docx	DOCX document	Dec 2, 2015
Draft_ENV_Tentative_Agenda_Oct_2015.docx	DOCX document	Nov 13, 2015
Form_5000-E_NCIC-III_Request_19Mar2015.xlsx	XLSX spreadsheet	Nov 13, 2015

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Table 1

	Directorate of Emergency Services Access Control Background Check Request Form
	PRIVACY ACT: AUTHORITY: Title 10 United States Code Section 301 Title 5 United States Code Section 2951 Executive Order 9397 dated Nov 22, 1943 (SSN). PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified. ROUTINE USES: Yur Social Security Number is used as an additional/alternate means of identification to facilitate filing and retrieval. DISCLOSURE: Disclosure of your Social Security Number is voluntary.
	Sec 1.
LAST NAME	Sec 2.
FIRST NAME	Sec 3.
MIDDLE NAME	Sec 4.
SSN XXX-XX-XXXX	Sec 5.
DATE OF BIRTH MM-DD-YY	Sec 6.
DL or ID CARD NUMBER & State of Issue	Sec 7.

PLACE OF BIRTH (City, State or Country)

Sec 8. Justification for this NCIC-III Criminal records check being submitted and conducted.

Sec 9. SPONSOR DATA	E-mail your request form encrypted to: USARMY.WSMR.IMCOM-CENTRAL.LIST.PHYSICAL-SECURITY@MAIL.MIL
Name of Sponsoring / Vouching Official
Sponsor's Organization:
Sponsor's phone number:
Date submitted:

PHYSICAL SECURITY APPROVAL:

EWS Form 5000, Current as of 19 March 2015

mailto:USARMY.WSMR.IMCOM-CENTRAL.LIST.PHYSICAL-SECURITY@MAIL.MIL

File details come from the government source that posted it. Updated Nov 14, 2017.