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Access Request Form-4 3

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solehledrya
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28 views4 pages

Access Request Form-4 3

Uploaded by

solehledrya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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ACCESS REQUEST (Rev 11/2019)


11/18/2024 13:33
PREVIOUS VERSIONS WILL NOT BE ACCEPTED
PLEASE BE SURE TO FILL OUT EACH COLUMN OR YOUR REQUEST WILL NOT BE PROCESSED
After completing this form, save and then send as an email attatchment to the following address: visitrequest@colonnaship.com
BY SUBMITTING THIS VISIT REQUEST - THE REQUESTOR VERIFIES THE CITIZENSHIP AND HAS DOCUMENTATION ON FILE FOR EACH PERSON LISTED.

PRIOR TO FACILITY ACCESS, WORK PERFORMANCE AND PAYMENT, a current and fully compliant Certificate of Insurance must be on file. Instructions at: www.colonnaship.com/subcontractors/insurance-requirements/

Last 4 SSN, Passport #, or MIDDLE REASON FOR VISIT


FIRST NAME DOB CITIZENSHIP START DATE END DATE YOUR COMPANY NAME & CONTACT INFO SUBCONTRACTED TO
PR # INITIAL
LAST NAME TYPE: Vessel Name, Shop, Trade, BLDG, or Training Class
7668 PARSIO M 11/30/1965 USA YRBM-27 5/27/2022 8/1/2022 MARIO BLANCO CONSTRUCTION MARIO BLANCO

visitrequest@colonnaship.com
5/27/22 8:56 AM
ACCESS REQUEST FORM-4.xls
Page1
www.colonnashipyard.com
Access Request Instructions:

Column A Last 4 SSN Last FOUR of employee's SSN ONLY.


Column B Last Name Employee's Legal Last name (Must match the emloyee's I
Column C First Name Employee's Legal First name (Must match the emloyee's
Column D Middle Initial Employee's Middle initial. If no middle name enter NMN.
Column E DOB Employee's date of birth.
Column F Citizenship If employee was born in the US or US territories type "Yes
Column G Reason for Visit Type the reason for the visit - i.e. vessel name, inspection
Column H Start Date Date your employee's visit will be starting.
Column I End Date Date your employee's visit will be ending.
Column J Company Name & Contact Info Companies name and point of contact information.
Column K Subcontracted To Enter name of staffing agency employee is working with th

Access Request Submission Timelines:

Requests received after 2PM will be ready for badge pickup after 1PM the following day.
Requests received between 6:30-11:00 AM will be ready for badge pickup after 1PM that d
Requests received between 11:00 AM-2:00 PM will be ready for badge pickup after 6:30 A

Pass & ID office is open Monday - Friday from 0630-1500. Closed on Federal holidays.

2
LY.
match the emloyee's ID Card)
match the emloyee's ID Card)
dle name enter NMN.

US territories type "Yes". If employee was born outside of the US or US territories type "No" (attach Proof of Citizensh
essel name, inspection, etc..
tarting.
MUST HAVE AN END DATE.
act information.
loyee is working with through your company. Or N/A if not applicable.

he following day.
kup after 1PM that day.
pickup after 6:30 AM the following day.

3
attach Proof of Citizenship to your email).

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