Fillable Dd Form 2249 Draft - Dod Building Pass Application (Page 2 of 2) in pdf

Dd Form 2249 Draft - Dod Building Pass Application Page 2

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DOD BUILDING PASS APPLICATION

(TEMPORARY/NCIC REQUEST)

9. NAME OF APPLICANT

a. LAST

b. FIRST

c. MIDDLE INITIAL

10. SOCIAL SECURITY NUMBER

11a. DATE OF BIRTH (YYYYMMDD)

b. COUNTRY

12. PHYSICAL DESCRIPTION (This data is requested for identification purposes only, and is not a factor in determining eligibility.)

a. RACE (Mark one or more)

(1) AMERICAN INDIAN OR ALASKA NATIVE

(4) HISPANIC OR LATINO

(7) OTHER

(5) NATIVE HAWAIIAN OR

(2) ASIAN

D R A F T

OTHER PACIFIC ISLANDER

(3) BLACK OR AFRICAN AMERICAN

(6) WHITE

c. HEIGHT (Inches)

d. WEIGHT (Pounds)

b. SEX (X one)

(1) MALE

(2) FEMALE

c. IF "NO," INDICATE IMMIGRATION NUMBER AND

d. EXPIRATION DATE

13. IS APPLICANT A U.S. CITIZEN? (X one)

COUNTRY

(YYYYMMDD)

a. YES

b. NO

14. BACKGROUND INVESTIGATION DATA

YEAR

MONTH

INITIALS

(1)

(2)

(3)

a. BACKGROUND INVESTIGATION

(BI) INITIATED

b. NATIONAL AGENCY CHECK (NAC)/

SPECIAL AGENCY CHECK (SAC) INITIATED

c. BI COMPLETED

d. NAC/SAC COMPLETED

e. NCIC COMPLETED

15. EMPLOYMENT CATEGORY (X one)

a. GOVERNMENT

c. CONTRACTOR

(1) 24 HOUR

e. ACCESS HOURS

(X one)

b. PRESS

d. PENTAGON RENOVATION

(2) BUSINESS HOURS ONLY

16. BUILDING ACCESS REQUESTED (X one)

c. DOES THE APPLICANT NEED

a. PENTAGON

(1) ESCORT

TO ESCORT OTHERS TO

PERFORM HIS OR HER

b. OTHER (Specify)

(2) NO ESCORT

DUTIES? (X one)

17. PASS INFORMATION

a. EXPIRATION DATE OF NEW PASS

b. REASON FOR ISSUANCE (X one)

(YYYYMMDD)

(1) INITIAL ISSUE

(2) RENEWAL

(3) NAME CHANGE

18. AUTHORIZED/REQUESTING OFFICIAL

a. NAME (Last, First, Middle Initial)

b. TELEPHONE NUMBER (Include area code)

c. SIGNATURE

d. DATE SIGNED (YYYYMMDD)

DD FORM 2249 (BACK), 20081031 DRAFT

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Dd Form 2249 Draft - Dod Building Pass Application Page 2

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