NCIC_CONSENT_FORM.pdf

NCIC CONSENT FORM

National Crime Information Center (NCIC) Inquiry Authorization and Waiver

1. In accordance with 596th Transportation Brigade Regulation 190-13, all persons requesting admittance to

Military Ocean Terminal, Sunny Point will be subjected to an NCIC inquiry. This inquiry is a criminal background check utilizing the Federal Bureau of Investigation (FBI) criminal database.

2. Individuals who are determined to have been convicted of serious crimes (felonies, as determined by state statutes); or pattern of criminal activity, which is determined to be prejudicial to good order and discipline on a military installation (as determined by the Provost Marshal, Senior Law Enforcement Official, or designated representative) will be denied access.

3. An NCIC inquiry will produce a complete criminal history background on the individual, which will be maintained on file at the Visitor Center, under the control of the installation Provost Marshal for one year. After one year, the documents will be destroyed. NCIC results will only be viewed by authorized MOTSU security personnel.

The NCIC results of persons denied access to MOTSU will not be maintained. Disclosure of information obtained through an NCIC inquiry is governed by the North Carolina State Bureau of Investigation and the FBI.

This form is to be completed by the applicant. All areas below are MANDATORY. Incomplete information will be returned to the applicant without action.

I (print FULL NAME: FIRST, MIDDLE, LAST)________________________________________________________, have read the information presented above and understand the contents. I specifically authorize and voluntarily consent to a National Crime Information Center background check conducted by the 596th Transportation Brigade Provost Marshal’s Office for the purpose of obtaining access to the Military Ocean Terminal, Sunny Point.

Signature of Requestor Today’s Date

Date of Birth Race Gender Place of Birth (City and State)

Social Security Number Driver’s License #/State Street Address

Are you currently on probation or parole? YES___ NO___ ______________________________ City, State Do you currently have pending charges? YES___ NO___ Are you a US Citizen? YES___ NO___ Zip Code

Company Name Telephone Number (Home or Cell)

Military Ocean Terminal, Sunny Point, Point of Contact and Telephone Number

(CONTRACTORS ONLY)

**NOTE**If your Driver’s License has the “NOT FOR FEDERAL IDENTIFICATION”, you must have another form of Government Photo ID to enter Sunny Point Military Ocean Terminal. This is IAW Dept. of Homeland Security REAL ID Act.