Nawscl Form

INSTRUCTIONS NAWSCL BADGE REQUEST CHECK BLOCKS S FOR AREA S REQUIRED. Submit completed NAWS 5530/1 Rev. 03-2013 Name of Applicant Last First MI SSN Complete Date of Birth original to approving code. Sponsors are responsible for obtaining the appropriate approvals for restricted area s access. Work / Contact Phone Departure Date Arrival Date Citizenship If not USA Provide Passport / Permanent Residency Employer Job Title Clearance Level SMO Verification Name/Phone Grade CAC / NCAC Vehicle Identification License State Registered Owner Policy Insurance Company Code Expiration Exp Dtd Model Year Decal If Issued Color of Doors Badge Type FN Case Area Access Badge DoD Dependent FN O/V One - Day Access Community In-Vehicle FN Guest Approval Required FN Day Pass Identify area to be visited Temp Badge NCAC Application Pending 28 Days Contract Other Type Other Authorized Controlled Area Access Note Sponsors are responsible for obtaining required area access approvals. X No E Escort Escort AREAS APPROVING CODE Required Req d Administration - Bldg. 00001 N3AT Foreign National Approval Sponsor s Initials N00 00 7. 0 10. 0 PAO 11. 0 China Lake Police - 00001 APPROVING OFFICIAL NAME / TITLE / SIGNATURE N3AT 741000D/E C - CLPL N3AT 4. 7 Per Memo F - Flight Line N3AT N46NS 450000D N3/N32 410000D/E VX-9 VX-31 M - Michelson / Lauritsen Laboratories N3AT/NAVAIR N - North Restricted Areas R - Remote North/SouthTest Range 5. 2 Per Designation Memo S - ECRD South Test Range P - Photography Privileges N3AT N00 N3/N32 ISO ICO NAWS Air Ops Officer N3AT N00 NAWS Badge or Last 5 SSN ISO ICO V - Vouching Privileges Sponsor s Name Please Print and Sign Applicants acknowledge they have read and will comply with the Statement of Agreement on the back of the application* Name Please Print and Sign Date Security Approval Name/Signature Phone Applicant s Signature Privacy Act Statement AUTHORITY 10 U*S*C. 5013 10 U*S*C. 5041 OPNAVINST 5530. 14D Navy Physical Security EQ 9397 PRINCIPAL PURPOSE To maintain all aspects of proper access control to issue badges replace lost badges and retrieve badges upon separation to maintain visitor statistics collect information to adjudicate access to facility and track the entry/exit times of personnel* ROUTINE USES Information can be furnished to Federal State or local agencies foreign governments and designated contractors. DISCLOSURE Voluntary however refusal to furnish requested information can result in inability to verify essential personal information and/or disapproval of requested access application* Statement of Agreement I agree to the following terms for the control and use of the Naval Air Weapons Station China Lake NAWSCL badge issued to me 1. I am responsible for the security of the badge and will not leave it unsecured at any time. I will use the badge only for the purpose issued and I will not loan the badge to any other person or use it to bring unauthorized persons onto NAWS* I have read and I understand the Security Warning and the Privacy Act Statement on this form* 2.