FN Contractor Sec Access Form.pdf
PDF 29 KB Posted
- Solicitation number
- W912P527QA001
About this file
This document is a Foreign National Security Form used by the Nashville District Corps of Engineers to process security clearances for non-U.S. Citizens working on federal contracts or task orders.
All non-U.S. Citizens, including permanent residents, must obtain approval from the Headquarters U.S. Army Corps of Engineers Foreign Disclosure Officer (FDO) or higher authority before beginning work. No contractor or subcontractor may access the worksite until written approval is provided. Contractors must submit the following information: full name (Last, First, Middle), date of birth, country of citizenship, passport number (color scanned copy), visa number and copy (unless the country participates in the Visa Waiver Program), description of work to be performed, Corps of Engineers work location, site access dates, expected arrival date, job title, payment method, and primary company point of contact information with phone and email. Additionally, contractors must provide documentation verifying legal admission to the United States and possession of an employment or immigrant visa. Non-U.S. Citizens who have resided in the United States for at least three years must obtain a favorable background investigation in accordance with Homeland Security Presidential Directive 12 (HSPD-12). Security clearance inquiries should be directed to Tracy Dorrough (Security Technician, primary contact for personnel security investigations) at 615-73-7397 or tracy.dorrough@usace.army.mil, or Jay Klinger (Security Specialist) at 615-736-2185 or jason.j.klinger@usace.army.mil.
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Other files
| File | Type | Posted |
|---|---|---|
| US Citizens Security Access Form.pdf | ||
| Solicitation Amendment W912P527QA0010001 SF 30.pdf | ||
| Solicitation - W912P527QA001.pdf |
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Text version
COMPANY NAME / ADDRESS / MAIN PHONE #
Nashville District Corps of Engineers
Foreign National Security Form
NOTE: At no time will a Contractor or Subcontractor be permitted to access the site until approved by the Nashville District and the Contractor Official has been notified in writing.
All non-U.S. Citizens, including permanent residents who work on Nashville District (LRN) contracts or task orders shall be approved by the Headquarters U.S. Army Corps of Engineers (HQUSACE) Foreign Disclosure Officer (FDO) or higher before beginning work on the contract/task order.
Date Request is Being Submitted to the Security Office: (mm/dd/yyyy) ______________________________
FULL Name_______________________________________________________________________
(Last, First, Middle)
• If you have only initials in your name, use them and state (IO). If you have no middle name, enter “NMN”
• If you are a “Jr.,”Sr.,” “II,” etc., indicate your status
Date of Birth (mm/dd/yyyy): _________________ Citizenship (Country): ______________________
Passport # (Include copy scanned in color): _____________________________________________
Visa # (Include copy scanned in color if applicable): _______________________________________
* Visa information must be included unless country of citizenship is in the Visa Waiver Program
Work to be Performed:______________________________________________________________
Corps of Engineers Location (Project Office/ Work Site) Where Work is to be performed:
From & To Dates for Requested Site Access: ____________________________________________
Expected Arrival Date: ___________________ Job Title: ___________________________________
Method of Payment (U.S. Dollars, Euros etc.): ___________________________________________
Primary Company POC Name/Phone: _________________________________________________
Primary Company POC Email Address: _______________________________________________
In addition to the information above, the Contractor shall furnish documentation to verify he/she was legally admitted into the United States and has an employment or immigrant Visa (unless in the Visa Waiver Program). This includes, individuals living and working in the United States but are not U.S. Citizens, such as permanent residents.
In addition to the requirements above, all non-U.S. Citizens who have lived in the United States for at least three years must also have or obtain a favorable background investigation in accordance with Homeland Security Presidential Directive 12 (HSPD-12) (guidance provided separately).
Nashville District Corps of Engineers Security Office Contact Information:
*Tracy Dorrough, Security Technician, 615-73-7397 email: tracy.dorrough@usace.army.mil Jay Klinger, Security Specialist, 615-736-2185 email: jason.j.klinger@usace.army.mil
* Primary - Personnel Security Investigations mailto:tracy.dorrough@usace.army.mil mailto:jason.j.klinger@usace.army.mil
| COMPANY NAME ADDRESS MAIN PHONE: |
| FULL Name: |
| Citizenship Country: |
| Work to be Performed: |
| Job Title: |
| Primary Company POC NamePhone: |
| Primary Company POC Email Address: |
| Location: |
| Date of Birth: |
| Date of Request: |
| Passport Number: |
| Visa Number: |
| Dates for Site Access: |
| Method of Payment: |
| Arrival Date: |
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