Usfk Reg 190 7 2004

RESET DATE APPLICATION FOR INSTALLATION/BASE PASS USFK FORM 37EK USFK REG 190-7 SEE PRIVACY ACT STATEMENT ON REVERSE 20 - SEP - 2005 SECTION I - TO BE FILLED OUT BY SPONSOR AND APPLICANT TYPE OR PRINT PERMANENT INITIAL TEMPORARY ACCESS AREA If USFK or EUSA Special processing required FPCON A B C D RENEWAL ESCORT PRIVILEGES TIME UPDATE DAYS B SHORT-TERM VISIT REQUEST US DoD ONLY MAY APPLY Not to exceed 60-Days 1. NAME LAST FIRST MIDDLE 4. DOB YYMMDD 5. HEIGHT 2. SEX 6. WEIGHT 7. HAIR FEMALE MALE 8. EYES 3. KID/SSN OR PASSPORT 9. GLASSES YES 10. POB CITY/COUNTRY NO 11. CURRENT ADDRESS PHONE NO. ST NO. CITY PROVINCE 12. SPONSOR FULL NAME/RANK 13. SPONSOR SSN 14. SPONSOR ORG PHONE NO. 15. JUSTIFICATION FOR PASS OR VISIT ATTACH PHOTO-COPY OF KID CARD OR PASSPORT SPONSOR STATEMENT OF UNDERSTANDING I fully understand my responsibilities as a sponsor for the control of the person identified at the top of this application* All information submitted is true and ccorrect to the best of my knowledge. I further understand that it is my responsibility to ensure that I notify the Installation Pass ID Office of any change in my status as a sponsor or any knowfedge of misuse of the pass to be issued* It is my responsibility to ensure that the pass is returned to the Installation Pass ID Office if it is not renewed or expires prior to my DEROS* If this Pass is issued to an employee or contractor upon termination of employment or services being provided I will ensure the issued pass is returned to the Pass and ID Office. Failure to comply with these requirements may result in the loss of sponsor privileges or imposing legal or other administrative actions against me. SIGNATURE OF SPONSOR USFK FORM 82-E 1 JUL 04 PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE* 16. GRADE/RANK 17. JOB TITLE 18. DATE OF EMPLOYMENT 19. UNIT/AGENCY/COMPANY ADDRESS/PHONE NO. 20. PAY ACCOUNTING NO. 21. CONTRACT NO. 22. CONTRACT PERIOD YYMMDD-YYMMDD 23. BACKGROUND CHECK WITH LAST 5 YEARS 24. DATE COMPLETED 25. IS APPLICANT A DESIGNATED COUNTRY PERSON DCP a* COPS b. KNP 26. REQUESTED BY US O-6 OR DoD CIV EQUIVALENT 27. MISSION/EMERGENCY ESSENTIAL As designated by TDA/Job Position 28. DATE PASS ISSUED c* US Embassy 29. PASS EXPIRATION DATE I HAVE REVIEWED THIS APPLICATION AND IT S SUPPORTING DOCUMENTS* ALL DOCUMENTS SUPPORT OR DO NOT SUPPORT APPROVAL OF THIS PASS REQUEST. 30. SIGNATURE OF PASS ID SECTION CHIEF OR NCOIC SECTION IV - REQUESTING APPROVING AUTHORITY SIGNATURE US 0-6 OR DOD CIV EQUIVALENT OR HIGHER CHAP 2. THE APPLICANT HAS NO DEROGATORY INFORMATION THAT WOULD PROHIBIT APPROVAL OF THIS REQUEST. Recommend Approval Disapproval SIGNATURE Approve US 0-6 OR DOD CIV EQUIVALENT OR HIGHER PRIVACY ACT STATEMENT 1. AUTHORITY Title 10 USC 3012 g. 2. PRINCIPAL PURPOSE S Use of Social Security Number or Korean Identification number is an additional means of identification of individuals. 3. ROUTINE USES An individuals Social Security Number or Korean Identification number together with name and other personnel identifying data may be used for the collection of derogatory information on file within DoD host nation and other LawEnforcement Agencies in determining an individuals suitability for access to USFK installations in Korea* 4.