10-R-0014Access.pdf

BASE ACCESS FORMS

Current Base Pass Procedures- October 2009

The contractor must submit the following in order to gain access to Eglin, Camp Rudder or Duke field at least 7 (seven) business days prior to date of access:

A Memorandum request via fax, or in person at to the Eglin Resident Office.

Hand deliver or mailed to the East Gate (Valparaiso/Niceville gate) Eglin AFB Contractor Access Affidavit and I9 form. All paperwork turned into the east gate needs to be placed in an envelope/folder with the company name, point of contact/number and contract number.

96 Security Forces Building 272 Attn - Pass and Registration Eglin Air Force Base, FL 32542

Delivery POC - Tim Scott at 850-882-7500

(NO EMAILS WILL BE ACCEPTED!!)

The request letter must be on the company letter head. Include the building number/name/location of duties, a brief description of their duties, the dates of requested access (not to exceed one year or the contract period), the contract number, name of individual requesting access, company employed with, days/hours of access, and the SSN of individual. This must also be signed by the POC/sponsor in your office whom is responsible for the employees. The sponsor’s information should include full name, SSN, title, company, and duty phone. The list of individuals is not limited to a specific number.

If you have 15 names being submitted and 6 of those names need to be Mon-Sun and the other 9 need Mon-Sat, please send the 6 on a separate letter than the 9 so that they don’t end up shorted a day on their pass.

Day laborers will only be issued passes for 2 weeks at a time.

There is no loop hole to the six day wait. There will be NO ESCORTS and no one day passes without the background checks.

There will be no notification after the individual has been entered into the system. After 7 business days you can go to the East or West gate between 6 am and 10 pm to pick up your pass. At the end of the month all pass requests will be returned to the contractor.

These need to be kept until the end of the contract.

To obtain the Access Badge after the six days, the individual will proceed, with two forms of identification to Pass and Registration at the Visitors’ Center at either East\Niceville or West\Ft Walton Beach Gate. Pass and Registration will verify and issue the ID. You only have 30 days to pick up the pass.

While the pass request is only good for 30 days the back ground check is good for 1 year.

You can submit for a background check at any point in time without requesting base access. So if you, a contractor, know you will need access Nov 13th and its currently July 18th you can submit the paperwork to get the background check complete and wait to submit the pass request.

Please be sure that your subs know how long you have entered them for a pass. If the people at the visitor center ask how long they are going to be on base they need to give this date. Even if they’re only going to be here 2 days this week and 2 days 3 weeks from now. The people at the gate do not need to know this and may send them away without the pass!

It is the responsibility of the hiring contractor to collect badges of all personnel once employment has been completed and/or terminated at Eglin Air Force Base, no matter the length or type of badge given. Return collected badges to the Eglin Security Forces at the East Gate. The base will not issue another badge if the previous expired badge has not been turned in. This is a very serious issue and security will hold all unreturned badges against the contract.

If an individual loses a badge, they must report it to the Prime Contractor. A new Memorandum must be sent with “Lost/Re-issue” next to the individual’s information.

Once notified that they have been processed through the computer, they should proceed to Pass and Registration to receive a new badge. A Pass and Registration clerk will notify the contract administrator/officer if the individual has a history of two or more lost badges, and could be denied access to the installation. The responsible contractor's project manager will investigate the loss and prepare a memorandum detailing the circumstances surrounding the loss. This memorandum will be forwarded to the contracting officer/ administrator, who must sign the memorandum (original signature only). The memorandum of the lost badge must be brought to Pass and Registration before a new badge will be issued.

The Eglin Resident office will work with you as much as possible to ensure all requirements are met. This policy is subject to change on short notice due to Real World conditions. We will make every attempt to provide guidance during these times. If you have any questions please contact, the Eglin Resident Office at (850) 882-7023; Fax

(850) 882-3600.

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EGLIN AIR FORCE BASE CONTRACTOR ACCESS BADGE AFFIDAVIT

AUTHORITY: Section 3101, Title 44, United States Code, AFI 33-332,5 USC 552A PRINCIPAL PURPOSE(S): Used for requesting personal information to assist security personnel in developing records to document contractor employee suitability for access to Eglin Air Force Base, Florida to work under Air Force contracts. The Social Security Number (SSN) and Date of Birth (DOB) are necessary to identify the person and records. This information may be used to determine suitability of persons desiring access to Eglin Air Force Base as well as for other lawful purposes including law enforcement and litigation. INTENDED USE: All contractors, subcontractors, unit's or sponsoring activities who have employees not authorized a Common Access Card or security clearance and requires access to Eglin Air Force Base in performance of their official duties, and/or whose contract expires in less than one year. DISCLOSURE: Disclosure of requested information is mandatory. Failure to provide information will result in access privileges being refused or withdrawn. The Privacy Act Statement will apply throughout the duration of the Air Force contract while serving in the capacity of prime contractor or subcontractor/supplier employee.

1. COMPANY NAME/PHONE NUMBER:

WORK. SITE LOCATION:

TYPE OF WORK. (EMPLOYEE):

DAYS OF THE WEEK AND HOURS REQUESTING AUTHORIZATION TO ENTER EGLIN AFB FOR

BUSINESS PURPOSES ONLY: (Circle all that apply) Mon Tues Wed Thurs Fri Sat Sun Earliest entry hour: Latest entry hour:

2. LAST NAME (ADD SUFFIX (SR., JR.) :

3. FIRST NAME: MIDDLE NAME:

4. OTHER NAMES ALSO USED (if none, write "NONE") SOCIAL SECURITY NO:

5. DATE OF BIRTH (MONTH) (DAY) (YEAR)

6. DRIVER LICENSE NO.: STATE

7. STREET ADDRESS (No P.O. BOXES): HOME PHONE:

8. CITY:

9. STATE: ZIP:

10. COUNTRY OF CITIZENSHIP

11. RESIDENT ALIEN NO. OR IMMIGRATION DOCUMENT NO. AND DESCRIPTION:

12. BIRTHPLACE (CITY/STATE/COUNTRY):

13. MALE: FEMALE: RACE:

14. HAIR COLOR: EYE COLOR: HEIGHT: WEIGHT:

15. PHYSICAL BODY CHANGES OR TATTOOS:

16. VEHICLE MAKE MODEL: COLOR: PLATE#: STATE:

17. WORK. HISTORY ON

EGLIN AFB

FROM: TO: EMPLOYER:

The information on this form is being collected in accordance with, federal law permitting the installation commander to limit access to the installation for security reasons (50 U.S.C. Section 797 and DoD Directive 5200.8). This data will be used to screen individuals who have or are seeking access to Eglin Air Force Base, Florida. Failure to provide truthful, complete and accurate responses may be used as a basis to deny entry to Eglin Air Force Base and is also punishable as a criminal offense.

Please answer each of the following questions by circling the correct answer. The information you provide will be verified through state and federal criminal history record checks.

Can U.S. citizenship, immigration status, or Social Security Account Number be verified? YES NO Have you ever been barred from entry/access to any Federal/military installation or facility? YES NO Are you wanted by federal or civil law enforcement authorities, regardless of offense/violation (i.e., an “order to arrest” has been issued by a judge?

YES NO

Have you been incarcerated for 12 months or longer within the past ten years, regardless of offense/violation, unless released on proof of innocence?

YES NO

Does your name appear on any federal agency's "watch list" or "hit list" for criminal behavior or terrorist activity?

YES NO

Are you unable to obtain a favorable National Agency Check w Inquiries (NACI)? YES NO Have you ever been convicted of espionage, sabotage, treason, terrorism or murder? YES NO Have you been convicted of sexual assault, armed assault/robbery, rape, child molestation, drug possession with intent to sell, trafficking in humans, registered sex offender or drug distribution within the past ten years?

YES NO

Are you an undocumented, non-U.S, citizen (Foreign National)? YES NO Have you ever conspired or attempted to commit any of the criminal acts listed above? YES NO

NOTE TO APPLICANT: ATTESTATION

I understand that by signing this application, the information I have provided on this application is true, complete, and connect to the best of my knowledge and belief and is provided in good faith. I understand that a knowing and willful false statement on this application can be punished by barment from the installation, a fine, imprisonment or both. (18 U.S.C. Section 1001).

Further, I understand that under the authority of 50 U.S.C. Section 797 and DoDD 5200.8, the installation commander has imposed a continuing obligation for me to disclose to Eglin Air Force Base, within 24 hours, if I am convicted or found not guilty by reason of insanity of any of the above criminal offenses that occurs while I have unescorted access authority within Eglin Air Force Base.

Applicant Name__________________________________________________________________ (Print legibly)

Applicant Signature_______________________________________________________________

Date______________________________________________

Company Name___________________________________________________________________

Company Representative___________________________________________________________________ Printed Name Signature