"Application for Buckley Identification Card" - Colorado

Application for Buckley Identification Card is a legal document that was released by the Colorado Department of Military and Veterans Affairs - a government authority operating within Colorado.

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Download "Application for Buckley Identification Card" - Colorado

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STATE OF COLORADO
DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
6848 South Revere Parkway
Centennial, Colorado 80112
Phone (303) 677-8801
Fax (303) 677-8811
Bill Owens
Governor
Major General
Mason C. Whitney
The Adjutant General
Policy Letter: DMVA 604-1
Subject: Buckley Air Force Base Security Badges
Effective Date: June 1, 2003
Summary: Provides procedures for issuing security badges for Buckley Air Force Base
Applicability: All State Employees of DMVA
Staff Proponent:
Director of Personnel
Supercedes: New
Official:
William L. Robinson
Deputy Director
STATE OF COLORADO
DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
6848 South Revere Parkway
Centennial, Colorado 80112
Phone (303) 677-8801
Fax (303) 677-8811
Bill Owens
Governor
Major General
Mason C. Whitney
The Adjutant General
Policy Letter: DMVA 604-1
Subject: Buckley Air Force Base Security Badges
Effective Date: June 1, 2003
Summary: Provides procedures for issuing security badges for Buckley Air Force Base
Applicability: All State Employees of DMVA
Staff Proponent:
Director of Personnel
Supercedes: New
Official:
William L. Robinson
Deputy Director
DEPARTMENT OF MILITARY & VETERANS AFFAIRS
BUCKLEY AIR FORCE BASE ENTRY BADGES – PROCEDURE
All Department of Military & Veterans Affairs state employees requiring access to
Buckley Air Force Base must possess a special badge issued by the Air Force
Security office at Buckley. The procedure for obtaining said badges is as follows:
1. Access for personnel who do not work at Buckley will be determined by their
supervisor. The supervisor will provide an electronic roster of those personnel to
the State Personnel Office at
edrie.womack@dma.state.co.us
indicating whether
escort privileges are required (see 4 below).
2. Authorized employees (which includes all employees who work at Buckley) can
obtain an application form from the State Personnel Office at 6868 S Revere Pkwy.,
Ste 260, Centennial CO
3. The demographic section of the form must be completed by the employee and then
signed by the State H R Director or the State Deputy Director.
4. Escort privileges will be denoted by an “E” on the badge. This will authorize the
employee to escort contractors and others who do not have a badge onto the Base.
5. The state H R Director will deliver the form(s) and a roster to Buckley Air Force
Base Security as required.
6. Buckley Security will run a background check on each individual through CBI. A
successful CBI check becomes a condition of employment for Buckley employees.
7. Once the employee has been approved for a badge, the State H R Director will
notify the appropriate supervisor.
th
8. The employee must then go, in person, to the Visitor’s Center at the 6
Avenue
Gate at Buckley where a picture will be taken and a badge issued.
9. Badges will be issued for a maximum of five (5) years.
10. The badge will authorize access 24/7. There will be no special badge issued for
essential or emergency essential employees. The badge will serve all purposes.
11. Badges are issued based on continued employment with the Department.
12. If and when an employee terminates, the badge must be returned to the State
Personnel Office at Revere.
13. The badges will then be returned by the State H R Director to Security at Buckley.
14. The roster of employees with badges will be regularly updated.
Attached is a sample of the application form filled out correctly as it should come
to the State HR Director.
Privacy Act Statement
Information Contained on this form is protected under the provisions of the Privacy Act of 1974. The unauthorized
disclosure of information contained hereon could result in severe disciplinary action.
Application For Buckley Identification Card
Section 1 Applicant information
Last Name, First MI
SSN
Hm Phone
ABDEC, IAN
123456789
3031234567
Driver’s License #
State of Issue
Wk Phone
12345678
co
3033456789
Address
Date of Birth
Sponsoring Agency, POC tel #
1234 anywhere st ANYTOWN, CO 12345
01/01/2001
DEPARTMENT OF MILITARY &
VETERANS AFFAIRS, 303-677-8725
Company
Contract #
Contract Expiration Date
N/A
N/A
N/A
Days of Installation Access
Times for Access
SUN., MON., TUE., WED., THURS., FRI., SAT.
24/7
Company Rep Phone #’s
Company Representative Title
Printed/Typed Name of Company
Representative
n/a
n/a
n/a
Is this application for a subcontractor?
Date
Company Representative Signature
yes
no
n/a
Section 2 Sponsoring agency information
Sponsoring Agency Phone #’s
Sponsoring Agency Title (unit, organization, or agency)
Who is the prime Contractor?
DEPARTMENT OF MILITARY & VETERANS AFFAIRS
303-677-8800
(work unit within DMVA), e.g. Civil
Engineering
Printed/Typed Name of Sponsoring Agency’s designated approving official
Date
Sponsoring Agency Signature
Edrie Womack
1/2/3456
Section 3 Contracting Office information
Contract Administrator’s Phone #’s
Contract Administrator/Authenticator’s
Contracting Office Organization
n/a
0
Signature
0
Applicant’s Signature
Printed/Typed Name of Contract Administrator/Authenticator
Date
15.
n/a
n/a
Issuing Official Use Only
Section 4
Today’s date
_____________
Badge Issuer’s Initials ______________
Badge Number __________
Badge expiration date ___________
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