DEPARTMENT OF HOMELAND SECURITY 

FEDERAL LAW ENFORCEMENT TRAINING CENTERS 

VISITOR & VENDOR ACCESS REQUEST 

Privacy Act Statement: 

Authority: 5 U.S.C. 301; the Homeland Security Act, codified in Title 6 of the U.S. Code; 44 U.S.C. 3101; and Executive Order (EO) 9397; EO 12968; and 

Federal Property Regulations, issued July 2002. 

Purpose: The purpose for collecting and maintaining this information is to allow individuals access associated with DHS/FLETC facilities and perimeter access 

control, as well as visitor security and management. 

Routine Uses: System of Records Notice (SORN) DHS/ALL-024 located at https://www.govinfo.gov/content/pkg/FR-2010-02-03/html/2010-2206.htm.

Disclosure: Disclosure of this information is voluntary. Failure to provide requested information may result in denial of access to the FLETC property. 

SECTION A - To be completed by Applicant 

1. Applicants Full Name:

(Last, First, Middle) 

Aliases Used (nicknames, maiden names, etc): 

2. Residential Address: Street Address:

City, State, Zip code: 

3. Driver's License: State: Driver's License #: 4. Date of Birth:

5. Place of Birth (City and State or Country): 6. Dual Citizen of another Country?: Yes No 

7. Country of Citizenship (List all that apply * ): (* If not a U.S. Citizen, you must complete the DHS Form 11055 or 11059) 

8. Gender Male Female 9. Social Security #: 10. Current PIV/CAC Card: Yes No 

11. Contact Information: Home or cell phone number: E-mail:

12. Last Date on FLETC: 13. Date Completed:

SECTION B - To be Completed by Sponsor (Must be a Federal Employee) 

1. Sponsor Name: Agency: 

E-mail Address: Office/Cell Number: 

2. Type of access requested for Applicant: Graduation Guest One Time Vendor Frequent Vendor Transporter 

One Time Visitor 5 Day or Less Contractor 

3. Class Number (if a Graduation Guest): 

4. Relationship to Applicant (if a Visitor):

5. Company Name (if a Vendor or a 5 Day or Less CTR): 

6. Requested Access Dates: Start Date: End Date: 

SECTION C - Type of Access (To be Completed by FLETC Security) 

1. Type of Access:

NCIC Only-Paper Pass: NCIC Only-Prox Badge: Fingerprints Required - Prox Badge: No NCIC - Prox Badge: 

5 day or less contractor PO Staff 

One Time Visitor PO Staff (If no PIV/CAC) 

Frequent Vendor 

Transporter 

One Time Vendor 

Graduation Guest 

2. NCIC Check:

No Results Found Results Found 

ARN:

FBI Number:

Notes: 

FLETC Form 121-00-02 (7/23) Page 1 of 1

PO Staff Frequent Visitor

Frequent Visitor
 

 

 

 

 

 

 

 

 

Instruction Page 

Limited access to FLETC facilities involves duties and responsibilities of limited relation to the 

agency or program mission. Personnel with limited access includes visitors, vendors, construction 

workers, utilities workers, pesticide control workers, etc. The types of personnel vetting conducted on 

these personnel are as follows: 

NCIC Check and Fingerprint Check (SAC) 

1. Frequent vendors with access to make

deliveries (Coca-Cola, food deliveries,

newspaper, FedEx, UPS, etc...)

2. Pest control personnel with no building

access

3. Groundskeepers

Proximity card – Limited to the hours of 

0600-1800 

Access for after hours, weekends, 

holidays must be requested in advance 

4. Transporters

NCIC Check Only - Paper Pass

1. One Time Visitors

2. Graduation Guests

3. One Time Vendors

4. 5 day or less Contractors

Paper badge - Limited to the hours of 

0600-1800 

Note: Contractors, volunteers, interns, consultants, etc., providing support services to FLETC and who 

require unescorted access to FLETC facilities, FLETC- controlled buildings, access to FLETC sensitive 

information, or access to IT systems, will require a full background investigation. The investigation type 

will depend on the type of access required. 

NCIC Check Only - Proximity Card

1. Frequent Visitor

2. PO Staff (If no PIV/CAC)