Holloman AFB MAP 1 Ace's Tenpin Cantina/Desert Lanes Bowling Center 2 Club Holloman 3 Apache Mesa Golf Course/ Patty Shack (Coming Soon) 4 Oasis Pizzeria & Sports Bar 5 Heritage Park & Museum Off Limits Areas Authorized Areas 11st St W Delaware Ave 3 2 1 6th St To Housing Commercial Gate Arizona Ave W Idaho Ave W New Mexico Ave 4 4th St Housing I-70 Yucca Alamogordo Blvd Mesquite Rd 5 Andrews Dr Yucca Arizona Ave Santa Fe Dr Housing Front Gate 1st St
BACKGROUND CHECK CONSENT FORM I,, (Name typed/printed) Hereby authorize the U.S. Government (United States Air Force) to conduct background checks confirming my eligibility or ineligibility to gain access to Holloman Air Force Base, New Mexico. Examples of conditions that may identify ineligibility to access the installation include, but are not limited to, substantiated misconduct, conviction or arrests for violent behavior, dishonesty, sexually aberrant behavior, warrants for arrest, open investigations, or felony charges. I do so with full knowledge that this information is confidential and as such protected from unauthorized disclosure by the Privacy Act of 1974, as amended. It is also my understanding that any information provided shall be treated confidentially and be used solely to determine whether I am eligible to access the installation. ADVISORY "I further understand that Holloman Air Force Base is a federal military installation and that any individual with an active warrant attempting to get access to this base will be detained and local law enforcement will be notified." PRINT LEGAL NAME: ***PRIVACY ACT INFORMATION*** SSN: SIGNATURE: DATE: BIRTH DATE: COMPANY: US CITIZEN? (Circle One): YES / NO ***IFANSWER IS NO SEE BELOW*** ***NON US CITIZEN MUST PROVIDE*** ***RESIDENT ALIEN # OR WORK VISA #*** PRIVACY ACT STATEMENT IAW the Privacy Act of 1974, the contents of this document contain privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you may have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information. Current as of Dec14
Current as of Dec14 BACKGROUND CHECK CONSENT FORM
3. The authorized routes of travel are highlighted on the attached map (Attachment 1). All shaded areas are off-limits for non-dod civilians. The following roadways may be used to access the approved locations: a. First Street: from the Main Gate to the intersection of Idaho Avenue. b. Idaho Avenue: from First Street to the intersection of Sixth Street. c. New Mexico Avenue: from First Street to the intersection of eleventh Street. d. Arizona Avenue: from First Street to the traffic circle of Eleventh Street/West Gate Avenue. e. West Gate Avenue: from the West Gate to the traffic circle of Eleventh Street/Arizona Avenue. f. Eleventh Street: from the traffic circle of Eleventh Street/West Gate Avenue to New Mexico Avenue. g. Sixth Street: from Arizona Avenue to Idaho Avenue. h. Fourth Street: from New Mexico Avenue to Idaho Avenue. 4. Violations of any of these rules are subject to expulsion as a Friend of Holloman without reimbursement, barment from the installation, as well as prosecution under Titles 10 and 18 of the US Code of Federal Regulations. 5. These guidelines will be reviewed as needed. Please contact the Visitor s Center at (575) 572-5951 for any questions regarding the above. Acknowledgement: Print: Email Address: Attachment: Map of Holloman AFB with shaded unauthorized areas Sign:
3. The authorized routes of travel are highlighted on the attached map (Attachment 1). All shaded areas are off-limits for non-dod civilians. The following roadways may be used to access the approved locations: a. First Street: from the Main Gate to the intersection of Idaho Avenue. b. Idaho Avenue: from First Street to the intersection of Sixth Street. c. New Mexico Avenue: from First Street to the intersection of eleventh Street. d. Arizona Avenue: from First Street to the traffic circle of Eleventh Street/West Gate Avenue. e. West Gate Avenue: from the West Gate to the traffic circle of Eleventh Street/Arizona Avenue. f. Eleventh Street: from the traffic circle of Eleventh Street/West Gate Avenue to New Mexico Avenue. g. Sixth Street: from Arizona Avenue to Idaho Avenue. h. Fourth Street: from New Mexico Avenue to Idaho Avenue. 4. Violations of any of these rules are subject to expulsion as a Friend of Holloman without reimbursement, barment from the installation, as well as prosecution under Titles 10 and 18 of the US Code of Federal Regulations. 5. These guidelines will be reviewed as needed. Please contact the Visitor s Center at (575) 572-5951 for any questions regarding the above. Acknowledgement: Print: Email Address: Attachment: Map of Holloman AFB with shaded unauthorized areas Sign:
3. The authorized routes of travel are highlighted on the attached map (Attachment 1). All shaded areas are off-limits for non-dod civilians. The following roadways may be used to access the approved locations: a. First Street: from the Main Gate to the intersection of Idaho Avenue. b. Idaho Avenue: from First Street to the intersection of Sixth Street. c. New Mexico Avenue: from First Street to the intersection of eleventh Street. d. Arizona Avenue: from First Street to the traffic circle of Eleventh Street/West Gate Avenue. e. West Gate Avenue: from the West Gate to the traffic circle of Eleventh Street/Arizona Avenue. f. Eleventh Street: from the traffic circle of Eleventh Street/West Gate Avenue to New Mexico Avenue. g. Sixth Street: from Arizona Avenue to Idaho Avenue. h. Fourth Street: from New Mexico Avenue to Idaho Avenue. 4. Violations of any of these rules are subject to expulsion as a Friend of Holloman without reimbursement, barment from the installation, as well as prosecution under Titles 10 and 18 of the US Code of Federal Regulations. 5. These guidelines will be reviewed as needed. Please contact the Visitor s Center at (575) 572-5951 for any questions regarding the above. Acknowledgement: Print: Email Address: Attachment: Map of Holloman AFB with shaded unauthorized areas Sign: