NASCC Guest Sponsorship - For visits less than 72-hours.xls

XLS spreadsheet 39 KB Posted

Attached to
Building 136 and Building 137 Roof Repairs at CCAD
Solicitation number
W912NW-23-R-0006
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FRONTPAGE

NAS CORPUS CHRISTI
GUEST SPONSORSHIP REQUEST
PLEASE CHECK THE APPROPRIATE BOXES TO INDICATE YOUR AFFILIATION TO THE BASEACTIVERESERVEDEPENDENTRETIREDCIVILIAN
SPONSOR: LAST NAME, FIRST NAME M Sanchez, Gilbertx
TO: SECURITY OFFICER, NASCCDATES OF EVENTHOME NUMBER
1 Feb 20231 Feb 2023
TYPE OF FUNCTION:HOURS OF EVENT
Site Visit to buildings 136 & 137 for roof repair.9:00 am12:00 pmCELL NUMBER
NUMBER OF GUESTS361-443-1500
LOCATION
Building 136 & 137WORK NUMBER:
361-961-6715
NAMEFULL SSN #DRIVER LICENSE & STATE OF LICENSEDATE OF BIRTHHOME/CELL PHONE
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Guest sponsors are responsible for any abuse that may arise from the guest's use of their credentials to access this installation. The guest sponsorship request takes (3 )working days to process. You should feel confident that a guest will honor and use this privilege in a responsible manner. Please take the time to communicate all of the policies that you observe while on this installation with each guest. Please be advised that your guest sponsorship privileges can be revoked if a guest is found in violation of base policies or federal statutes.
Sponsor's Signature X__________________________________________
SIGNATURE OF APPROVAL: Martin Wheeler
BY DIRECTION OF SECURITY OFFICER
X__________________________________________DATE:
FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE - Any misuse or unauthorized disclosure can result in both civil and criminal penalties. PRIVACY ACT STATEMENT AUTHORITY: Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act. PRINCIPAL PURPOSE: To record names, signatures, and Social Security Numbers for the purpose of validating the trustworthiness of

Individuals requesting access to Department of Defense (DoD) systems and information. NOTE: Records will be maintained in paper form. ROUTINE USES: None. DISCLOSURE : Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or prevent further processing of this request.

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