US Citizens Security Access Form

COMPANY NAME / ADDRESS / MAIN PHONE #

Nashville District Corps of Engineers
Security Access Form
(US Citizens Only)
NOTE: At no time will a Contractor or Subcontractor Employee be permitted to access the site until approved by the Nashville District and the Contractor Official has been notified in writing.
(Last, First, Middle)
• If you have only initials in your name, use them and state (IO). If you have no middle name, enter “NMN” •

If you are a “Jr.,”Sr.,” “II,” etc., indicate your status.

Note: Contractor shall furnish documentation to verify the employee is a U.S. Citizen if born outside the United States. Such documentation may include a U.S. passport (unexpired or expired), Certificate of U.S. Citizenship (INS Form N-560 or N-561), Certificate of Naturalization (INS Form N-550 or N-570) etc. Contractor shall furnish two forms of ID listed on Form I-9 for US Citizens.

PRIVACY ACT STATEMENT

AUTHORITY: Information is solicited pursuant to Title 10, U.S. Code, Section 3013 and E.O. 9397. PRINCIPAL PURPOSE: To provide information necessary for preparation of a scheduled tour of the facility, verify positive identification of visitor(s), and conduct background checks for determinations of the eligibility of access to U.S. Army Corps of Engineers facilities.
ROUTINE USES: Used by the U.S. Army Corps of Engineers to accompany a request for a scheduled tour of the facility. MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT OF NOT PROVIDING INFORMATION: Providing the solicited information, including Social Security Number, is voluntary; however, failure to provide information may result in a denial of visitor access due to an inability to verify identification. The information provided to the U.S. Army Corps of Engineers will not be retained digitally or by hard copy after the scheduled visit.

Nashville District Corps of Engineers Security Office Contact Information: * Mr. Dorrough, Personnel Security Specialist, 615-736-7397 email: [email protected] Mr. Klinger, District Chief of Security, 615-736-2185 email: [email protected] * Primary - Personnel Security Investigations

Version March 2025