Pass_Information_Sheet_(Base_Access_for_Site_Visit).pdf

FOR OFFICIAL USE ONLY

PASS INFORMATION SHEET

NAME OF COMPANY: DATE:

START DATE: 12/05/17 EXPIRATION DATE: 12/05/17

VALID DAYS: M T W TH F S Sun VALID TIMES: 0800-1600

SPONSOR’s NAME: SPONSOR PHONE #:

CONTROLLED

DRIVER’S AREA ESCORT

NAME SSN LICENSE/ DOB REQ REQ

Name SSN Drivers License

DOB Area Escort

Only the foreman and assistant foreman will have escort authorization on their contractor badges. Ensure individuals bring the following items to Pass and Registration; (1) Driver’s License, (2) Registration and (3) Proof of Insurance

SPONSOR SIGNATURE DATE

Privacy Act Statement PRIVACY ACT-1974 as Amended applies – This memo may contain information which must be protected IAW DOD 5400-11, and it is For Official Use Only (FOUO) AUTHORITY: 10 U.S.C. 8013; 44 U.S.C. 3101; and EO 93397 PRINCIPAL PURPOSES:

Used to record information and details of criminal activity which may require investigative action by commanders, supervisors, police, special agents, etc. ROUTINE USES:

Information may be disclosed to Pass and Registration to determine base access.

DISCLOSURE IS VOLUNTARY: SSN is used to positively identify the individual as a conduit to check past criminal activity records. Failure to provide the request information will affect your ability to gain access to March Air Reserve Base, CA.