Kirtland Air Force Base/sandia Laboratories - Criminal Background Check Information Form

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Criminal Background Check Information Instructions
If all sections of the form are not completed, the Air Force will NOT process the request. Failure to complete this
form will result in your denied access to Kirtland Air Force Base/Sandia Laboratories.
DIGITAL SIGNATURES WILL NOT BE ACCEPTED
Last Name: Insert your last name
First Name, Middle Initial: Insert your first name and middle initial
SSN: Insert your social security number
DOB: Insert your date of birth
Race: Insert your ethnicity (i.e. white, Hispanic, etc.)
Sex: Insert Male or Female
Eyes: Insert your eye color
Height: Insert your height
Weight: Insert your weight
Address, City, Zip: Insert your current address, including city, state and zip
U.S. Citizenship: Check “Yes” or “No” if you are a U.S. Citizen. If you are not a U.S. Citizen insert
your country of origin.
Driver’s License Number and State of Issuance: Insert your driver’s license number and write
the name of the state it was issued. If you do not have on write N/A.
Age 18 or Over: Check “Yes” or “No” if you are over the age of 18
Employer: Insert Sandia National Labs
Any Alias: Insert any other current or previous names you may have
Signature: Print and sign form when completed in ink.
Note:
If under 18 years of age, your parent or legal guardian must also sign the form directly above
your signature, authorizing KAFB to perform the background check.
If you have questions contact:
Nick Atencio
Contact
, Personnel Security Specialist, at 505-844-4391

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