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The SECNAV 5512 1 form serves a critical function in managing access to Department of Defense (DoD) installations and facilities. Designed specifically for local populations, this form facilitates the identification, verification, and authorization necessary for individuals seeking base access. Under the authority of various statutes, such as 10 U.S.C. 5013 and 10 U.S.C. 5041, the form collects essential personal details, including names, birth information, citizenship status, and various identity documents, ensuring that security protocols are followed. The process includes biometric data and checks against security databases, emphasizing the importance of safeguarding not only U.S. national security but also allied operations. Utilizing this form, individuals can apply for identification cards, report lost credentials, and even track their access history. Moreover, while providing the requested information is voluntary, failing to do so can result in denied access to vital military installations. The formal yet straightforward nature of this form underlines its necessity in our national security framework, where every detail contributes to a larger picture of defense and safety.

Secnav 5512 1 Example

OMB 0703-0061 Exp. 31 Mar 2017

DEPARTMENT OF THE NAVY LOCAL POPULATION ID CARD/BASE ACCESS PASS REGISTRATION

PRIVACY ACT STATEMENT:

AUTHORITY: 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 5041, Headquarters, Marine Corps; OPNAVINST 5530.14E, Navy Physical Security; Marine Corps Order 5530.14A, Marine Corps Physical Security Program Manual; and E.O. 9397 (SSN), as amended, SORN NM05512-2 .

PURPOSE(S): To control physical access to Department of Defense (DoD), Department of the Navy (DON) or U.S. Marine Corps Installations/Units controlled information, installations, facilities, or areas over which DoD, DON, or U.S. Marine Corps has security responsibilities by identifying or verifying an individual through the use of biometric databases and associated data processing/information services for designated populations for purposes of protecting U.S./Coalition/allied government/national security areas of responsibility and information; to issue badges, replace lost badges, and retrieve passes upon separation; to maintain visitor statistics; collect information to adjudicate access to facility; and track the entry/exit times of personnel.

ROUTINE USE(S): To designated contractors, Federal agencies, and foreign governments for the purpose of granting Navy officials access to their facility.

DISCLOSURE: Providing registration information is voluntary. Failure to provide requested information may result in denial of access to benefits, privileges, and DoD installations, facilities and buildings.

IDENTITY PROOFING AND APPLICANT INFORMATION

1. LAST NAME:

2. FIRST NAME:

3. MIDDLE NAME:

4. NAME SUFFIX:

Jr. Sr.

I

II III IV

5.

HISPANIC OR

 

 

 

 

 

 

 

 

 

6. RACE

 

 

 

 

AFRICAN AMERICAN

 

 

 

 

AMERICAN INDIAN OR

 

NATIVE HAWAIIAN

 

 

 

 

 

YES

 

 

NO

 

WHITE

 

 

 

 

ASIAN

 

 

OR OTHER PACIFIC

 

LATINO (Check one):

 

 

 

 

 

 

 

 

 

(Check one or more):

 

 

 

 

OR BLACK

 

 

 

 

ALASKIN NATIVE

 

ISLANDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

GENDER

 

 

 

MALE

 

 

FEMALE

8. DATE OF BIRTH:

 

9. CITY OF BIRTH:

 

10. STATE OF BIRTH:

11. BIRTH COUNTRY:

 

 

 

 

 

 

 

 

(Check one):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. US CITIZEN (Check):

 

YES

 

NO

13.DUAL CITIZENSHIP: YES NO CITIZENSHIP IF OTHER THAN US (Country) :

U.S. Citizen Minimum Documentation Required:

By Birth - Social Security No and/or State ID/Drivers License.

Naturalized - Certification Number, Petition Number, Date, Place and Court, United States passport number, Social Security No and/or State ID/Drivers License.

Derived - Parent's certification number, Social Security No and/or State ID/Drivers License.

Alien Minimum Documentation Required:

Registration Number, Expiration date, Date of entry, Port of entry.

14. IDENTITY SOURCE

15. DOCUMENT NUMBER:

16. ISSUED BY

17. ISSUED BY

18. ISSUED:

19. EXPIRES:

DOCUMENTS PRESENTED:

STATE/COURT:

COUNTRY:

 

 

 

Social Security No.

 

UNITED STATES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State ID/Drivers License

UNITED STATES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passport No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certification Number and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Petition Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Derived - Parent's

 

 

UNITED STATES

 

 

 

 

 

 

 

 

 

 

Certification Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alien Registration No.

 

 

UNITED STATES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Entry:

 

 

 

 

 

 

 

 

 

 

Port of Entry:

 

 

 

 

 

 

 

 

 

 

OTHER APPROVED IDENTITY SOURCE DOCUMENTS:

20.WEIGHT

(Pounds):

21.HEIGHT

(Inches):

22. HAIR COLOR (Check one):

23. EYE COLOR (Check one):

Blond

Brown

Black

Gray

Red

Brown

Green

Blue

Hazel

White

 

Silver

 

Auburn

 

Bald

 

Black

 

Gray

 

Violet

 

Unknown

24. HOME ADDRESS (Include city, state, zip code):

HOME PHONE (Include Area Code):

25. BASE SPONSOR'S NAME:

SPONSOR PHONE (Include Area Code):

EMPLOYMENT ACTIVITY INFORMATON

26.EMPLOYER NAME AND ADDRESS (Include city/state/zip code):

EMPLOYER PHONE (Include Area Code):

27.SUPERVISOR NAME AND ADDRESS (Include city/state/zip code):

SUPERVISOR PHONE (Include Area Code):

SECNAV 5512/1 (APR 2014)

FOR OFFICIAL USE ONLY WHEN FILLED - PRIVACY SENSITIVE:

Page 1 of 3

 

 

Any misuse or unauthorized disclosure of this information may result in both criminal and civil penalties.

 

OMB 0703-0061 Exp. 31 Mar 2017

28.Check the applicable box for WORK HOURS box or check the OTHER box and enter the work hours, then check the applicable for WORK DAYS:

WORK HOURS:

 

0600-1800

 

0800-1700

 

OTHER

 

 

WORK DAYS:

 

SN

 

M

 

T

 

W

 

TH

 

F

 

ST

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIOR FELONY CONVICTIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29. Have you ever been convicted of a Felony?

 

 

 

YES

 

NO

_______ Initial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REQUIREMENT TO RETURN LOCAL POPULATION ID CARD

30.I understand that I am required to return my Local Population Identification Card to the Base Pass Office when it expires or if my employment is terminated for any reason. ________ (initial)

AUTHORIZATION AND RELEASE AND CERTIFICATION

31.I hereby authorize the DOD/DON and other authorized Federal agencies to obtain any information required from the Federal government and/or state agencies, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Security Service (DSS), the U.S. Department of Homeland Security (DHS).

I have been notified of DON right to perform minimal vetting and fitness determination as a condition of access to DON installation/facilities. I understand that I may request a record identifier; the source of the record and that I may obtain records from the State Law Enforcement Office as may be available to me under the law. I also understand that this information will be treated as privileged and confidential information.

I release any individual, including records custodians, any component of the U.S. Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of compliance, or any attempts to comply with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me.

FALSE STATEMENTS ARE PUNISHABLE BY LAW AND COULD RESULT IN FINES AND/OR IMPRISONMENT UP TO FIVE YEARS.

BEFORE SIGNING THIS FORM, REVIEW IT CAREFULLY TO MAKE SURE YOU HAVE ANSWERED ALL QUESTIONS FULLY AND CORRECTLY.

I DECLARE UNDER PENALTY OF PERJURY THAT THE STATEMENTS MADE BY ME ON THIS FORM ARE TRUE, COMPLETE AND CORRECT

DATE _______________ SIGNATURE ________________________________________

FINAL DETERMINATION ON YOUR ACCESS: The Base Commanding Officer has final authority for determination on granting physical access to DON controlled installations/facilities under his/her jurisdiction.

BELOW COMPLETED BY BASE REGISTRAR PERSON CONDUCTING IDENTY PROOFING and NCIC CHECK

32. INFORMATION VERIFIED BY:

33. ENTERED IN C/S SYSTEM BY:

34. PASS ISSUE DATE:

35. PASS EXPIRATION DATE:

36. NCIC CHECK PERFORMED BY:

37. RESULTS OF NCIC CHECK:

 

NO RECORDS

 

RECORD IDENTIFIER

RECORD NUMBER:

38. RESULTS OF LOCAL RECORDS CHECK:

NO RECORDS

 

RECORD IDENTIFIER

RECORD NUMBER:

Office of Under Secretary of Defense Directive-Type Memorandum (DTM) 09-012, "Interim Policy Guidance for DoD Physical Access Control," December 8, 2009. DTM 09-012 requires that DoD installation government representatives query the National Crime Information Center (NCIC) and Terrorist Screening Database to vet the claimed identity and to determine the fitness of non-federal government and non-DoD-issued card holders (i.e. visitors) who are requesting unescorted access to a DoD installation. The minimum criteria to determine the fitness of a visitor is: 1) not on a terrorist watch list; 2) not on an DoD installation debarment list; and 3) not on a FBI National Criminal Information Center (NCIC) felony wants and warrants list. Additionally, SECNAV Memo, Policy for Sex Offender Tracking and Assignment and Access Restrictions within the Department of the Navy, of 7 Oct 08 and OPNAVINST 1752.3 established the Navy's policy on sex offenders, requiring Region Commanders (REGCOMs) and Installation Commanding Officers (COs) to prohibit sex offender access to DoN facilities and Navy owned, leased or PPV housing. This form describes the authority and purpose to collect and share the required information; and identifies the applicant/visitor and sponsor; and authorizes the DoD to perform the minimum vetting and fitness determination criteria. A favorable response on the vetting and fitness determination is required to receive access to DOD-controlled installation/facilities.

SECNAV 5512/1 (APR 2014)

FOR OFFICIAL USE ONLY WHEN FILLED - PRIVACY SENSITIVE:

Page 2 of 3

 

 

Any misuse or unauthorized disclosure of this information may result in both criminal and civil penalties.

 
Get Secnav 5512 1 PDF Form

Form Characteristics

Fact Name Details
Authority The SECNAV 5512/1 form is governed by multiple laws including 10 U.S.C. 5013 and 10 U.S.C. 5041, which grant authority to the Secretary of the Navy and the Headquarters, Marine Corps, respectively.
Purpose This form's main purpose is to manage physical access to Department of Defense installations and facilities. It helps in identifying individuals to ensure security while allowing access to authorized individuals.
Voluntary Disclosure Providing information on the SECNAV 5512/1 form is voluntary. However, failure to provide necessary information may lead to denial of access to benefits and installations.
Data Protection Information collected via this form is treated as confidential under the Privacy Act. Unauthorized disclosure may lead to criminal and civil penalties.

Guidelines on Utilizing Secnav 5512 1

Completing the Secnav 5512 1 form is essential for those seeking access to Department of Defense installations. Before starting, gather all necessary documents that will help verify your identity and provide accurate information. The following steps outline how to correctly fill out the form.

  1. Begin with the Identity Proofing and Applicant Information section. Input your Last Name, First Name, Middle Name, and any Name Suffix if applicable.
  2. Indicate your Hispanic or Latino status and select your Race from the provided options.
  3. Specify your Gender and provide your Date of Birth.
  4. Fill out your place of birth, including City, State, and Country.
  5. Confirm your citizenship by checking Yes or No for U.S. Citizen and for Dual Citizenship if applicable.
  6. If you are not a U.S. citizen, provide the relevant details regarding your citizenship.
  7. List an Identity Source and the corresponding Document Number, along with the Issued By information.
  8. Provide additional personal details: Weight, Height, Hair Color, and Eye Color.
  9. Write your Home Address and Home Phone number.
  10. Include the Base Sponsor's Name and their Phone Number.
  11. In the Employment Activity Information section, fill in your Employer Name and Address along with the Employer Phone.
  12. Provide your Supervisor Name and Address, as well as the corresponding Supervisor Phone.
  13. Check the applicable Work Hours and Work Days.
  14. Respond to the question regarding any Felony Convictions with Yes or No.
  15. Initial the statement about returning your Local Population ID card after employment termination or expiration.
  16. Sign and date the Authorization and Release and Certification section, ensuring all information is accurate.

What You Should Know About This Form

What is the purpose of the SECNAV 5512/1 form?

The SECNAV 5512/1 form is used primarily to control physical access to Department of Defense (DoD) and Department of the Navy (DON) facilities. It helps verify an individual’s identity through various methods, including biometric databases. Ultimately, it aims to enhance security while issuing badges, tracking entries and exits, and maintaining visitor statistics.

Who needs to fill out this form?

This form must be completed by anyone seeking access to Navy-controlled installations or facilities. If you are a contractor, employee, or visitor, you will need to provide the necessary personal information for verification purposes.

What information do I need to provide on the SECNAV 5512/1 form?

You will need to provide personal details including your name, date of birth, citizenship status, and identification documents like a Social Security number or state ID. Additionally, information about your employment and base sponsor is required. Accurate and complete answers are crucial for the approval process.

Is it mandatory to disclose all requested information?

While completing the form is voluntary, not providing requested information may lead to denial of access to benefits, privileges, and facilities. The information collected plays a critical role in ensuring safety and security at installations.

What happens if I provide false information on the SECNAV 5512/1 form?

False statements made on this form are serious offenses. Penalties can include fines and imprisonment of up to five years. Always review your answers carefully before submission to ensure accuracy.

How is my personal information protected after filling out the form?

Your personal information is treated as privileged and confidential. The DoD, DON, and authorized agencies take strict measures to safeguard your data against unauthorized disclosure or misuse.

What is the final step after submitting the SECNAV 5512/1 form?

The final determination for access is made by the Base Commanding Officer. They will assess your information and vetting results before granting or denying access to DoD-controlled installations.

Common mistakes

Filling out the SECNAV 5512/1 form can seem daunting, but avoiding common mistakes can simplify the process significantly. One frequent error is neglecting to provide complete identification information. It’s crucial to fill in your full name, including middle names and suffixes if applicable. Skipping these details can lead to confusion and possibly hinder your access to military installations.

Another mistake often made is in the section regarding citizenship status. Be sure to check the appropriate box for U.S. citizenship and provide necessary documentation or information if applicable. Failing to clarify this can delay your processing time and create access issues. Furthermore, many applicants overlook the requirement to provide accurate birth information, such as date, city, state, and country. Incorrect data here could lead to a verification failure.

Additionally, one must not forget the importance of document verification. Individuals are required to provide the document number and issuing authority for their identification sources. Failure to attach this infographic can result in unnecessary inquiries and delays. It’s a common oversight that can easily be rectified by double-checking before submission.

Another area where mistakes often occur involves work hours and days. Applicants sometimes forget to specify their work schedule, which can complicate the sponsorship verification process. Remember to check the appropriate boxes and precisely note any hours or days that may not fit the standard options provided.

Missing the section on prior felony convictions can be detrimental. Many applicants either leave this blank or answer without careful consideration. It’s important to provide honest and accurate information on this part of the form. Any discrepancies could lead to legal implications or denial of access to installations.

Many tend to overlook the home address section, making errors in their current living situation. Providing an incorrect or incomplete address can affect the processing of your application and potentially hinder your access. Always revisit this section to ensure accuracy.

Finally, the authorization and release section should not be taken lightly. Applicants sometimes forget to initial or sign where required. Diligently reviewing each section before submission can avoid such mistakes and encourage a smoother evaluation process.

In conclusion, successfully filling out the SECNAV 5512/1 form is achievable by being aware of these common pitfalls. Paying attention to detail and thoroughly reviewing your responses can help ensure a timely and successful application experience. Navigating these forms does not need to be overwhelming with a bit of care and attention.

Documents used along the form

The SECNAV 5512/1 form is essential for individuals seeking access to Department of Defense (DoD) installations. Several other forms and documents are commonly used alongside this form to ensure compliance with access requirements. Below is a list of related documents that you may encounter.

  • DD Form 1172-2: This form is used for issuing a Common Access Card (CAC) to eligible family members. It provides essential identification for accessing military installations and obtaining benefits.
  • Navy Security Policy 5512: This policy outlines the security measures implemented to protect Navy installations. It serves as a guideline for the processing and handling of access requests.
  • Form I-9: Required for employment verification, this form confirms an individual’s eligibility to work in the U.S. It is often necessary for contractors and employees who need access to military facilities.
  • SF-86: The Standard Form 86 is used for background investigations. It is usually required for individuals requiring security clearances within DoD installations.
  • DoD ID Card Application (DD Form 1966): This application is for individuals seeking a military ID or identification card. It is essential for accessing various benefits and installations.
  • NCIC Check Documentation: This documentation validates that a background check has been performed through the National Crime Information Center, critical for security assessments of individuals seeking access to installations.
  • Visitor Access Request (VAR): This request is essential for those without a CAC or ID card. It outlines the purpose of the visit and ensures that all necessary vetting steps are taken prior to granting access to installations.

Each of these forms and documents plays a crucial role in maintaining security standards within military settings. It is important to ensure you have all necessary paperwork when seeking access to DoD installations.

Similar forms

  • DD Form 2 (Retired): This form serves as an identification card for retired service members and their eligible dependents. Like SECNAV 5512/1, it facilitates access to military facilities and recognizes the holder's affiliation with the armed forces. Both documents are key for identity verification and physical access control.
  • Federal Form I-9: Used for employment verification, the I-9 form requires proof of identity and work authorization. Similar to SECNAV 5512/1, it collects personal information to verify eligibility for access to certain contexts, focusing on legal residency and citizenship.
  • Common Access Card (CAC): The CAC is issued to military personnel, eligible contractors, and some civilians. This card allows access to military installations and is proof of identity just like the SECNAV 5512/1. Both documents play critical roles in maintaining security and ensuring proper access to Department of Defense locations.
  • Privacy Act Release Forms: These forms enable federal agencies to disclose information from personal records. Much like the SECNAV 5512/1, they include a privacy statement and outline the conditions under which personal data may be shared, reinforcing confidentiality practices while facilitating access control.

Dos and Don'ts

When filling out the Secnav 5512 1 form, follow these essential do's and don'ts:

  • Do: Provide accurate and current personal information.
  • Do: Sign and date the form where indicated.
  • Do: Review the completed form for any errors or omissions.
  • Do: Ensure that you have all required identification and documentation ready.
  • Do: Return your Local Population ID Card when it expires or your employment ends.
  • Don't: Leave any required fields blank.
  • Don't: Provide false information, as it may lead to penalties.
  • Don't: Ignore the privacy statements and your rights regarding the information provided.
  • Don't: Submit the form without thorough verification of information.

Misconceptions

Understanding the SECNAV 5512/1 form is essential for those requiring access to U.S. Navy installations. There are several misconceptions surrounding this form that can lead to confusion. Here are seven common misconceptions explained.

  • Misconception 1: The information is optional. Many believe that providing information on the SECNAV 5512/1 form is entirely voluntary. However, while some sections may allow for omitted details, failing to provide critical information may result in denied access to installations.
  • Misconception 2: Only military personnel need to complete this form. This form is not limited to military members. Civilians, contractors, and other visitors who wish to access Navy facilities are also required to complete it.
  • Misconception 3: My personal data is not protected. There is a misconception that personal information provided on this form can be freely shared. In reality, the collected data is strictly regulated and used only for the intended security purposes.
  • Misconception 4: There are no consequences for providing false information. Some individuals may think they can provide inaccurate information without repercussions. However, providing false statements is a serious offense and can lead to legal ramifications, including fines and imprisonment.
  • Misconception 5: The vetting process is not thorough. Many underestimate the rigorous vetting process associated with the SECNAV 5512/1 form. The Department of Defense conducts extensive checks, including background investigations and identity verification.
  • Misconception 6: I can retain my access indefinitely. Another common misunderstanding is that once access is granted, it is permanent. Access can be revoked or may require renewal, particularly if employment status changes or if the ID card expires.
  • Misconception 7: My employment information is irrelevant. Some may believe that providing employer details is unnecessary. This information is crucial for verifying an individual's identity and facilitating proper background checks for security clearance.

Understanding these misconceptions is vital for ensuring a secure and efficient process for obtaining access to Navy installations. Accurate information and compliance with the requirements of the SECNAV 5512/1 form help protect both individuals and facilities.

Key takeaways

Filling out and using the SECNAV 5512/1 form is an important process for gaining access to Department of Defense (DoD) and Navy facilities. Here are key takeaways to consider.

  • Identity Verification: The form is designed to verify your identity using biometric databases and other associated data processing services.
  • Voluntary Disclosure: While providing information is voluntary, failing to do so may lead to denied access to various DoD benefits and facilities.
  • Clear Instructions: Complete all sections accurately. Inaccuracies can delay or prevent access.
  • Documentation Required: Specific documentation is needed based on your citizenship status, so be prepared with the necessary papers.
  • Return of ID Card: You must return your Local Population ID Card upon expiration or termination of employment.
  • Authorization for Background Check: By signing the form, you authorize the DoD and other federal agencies to conduct a background check.
  • Final Approval: The Base Commanding Officer makes the final decision on granting access to installations or facilities.
  • Confidential Information: The information collected is treated as confidential and is protected under privacy regulations.

Understanding these points can help ensure a smooth process when filling out the SECNAV 5512/1 form.

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