Jump Links
The SECNAV 5512/1 form plays a crucial role in maintaining security at Department of Defense (DoD) and Department of the Navy (DON) installations. This form is primarily used to register individuals for local population ID cards and base access passes, ensuring that only authorized personnel can enter sensitive areas. It collects essential information, including personal identification details, citizenship status, and biometric data, to verify an individual’s identity. The form also includes sections for employment information, work hours, and prior felony convictions, which are vital for assessing eligibility for access. Additionally, it outlines the responsibilities of the applicant, including the requirement to return the ID card upon expiration or termination of employment. Privacy is a key consideration, as the form is subject to the Privacy Act, and the information provided is treated with confidentiality. By adhering to the guidelines set forth in this form, the DoD and DON can effectively manage access to their facilities, thereby enhancing overall security and safety.
Preview - Secnav 5512 1 Form
OMB
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
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
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: |
|
|
|
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
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. |
|
Document Specifics
| Fact Name | Details |
|---|---|
| Form Purpose | The SECNAV 5512/1 form is used to control access to Department of Defense and Navy installations by verifying individual identities. |
| Legal Authority | This form operates under various laws, including 10 U.S.C. 5013 and 10 U.S.C. 5041, which govern the Secretary of the Navy and the Marine Corps. |
| Privacy Act Statement | It includes a Privacy Act Statement, ensuring that personal information is collected and used in compliance with federal privacy laws. |
| Voluntary Disclosure | Individuals may choose to provide information voluntarily; however, failure to do so can lead to denied access to facilities. |
| Identity Proofing | The form requires various identity proofs, including Social Security numbers and state-issued IDs, to verify the applicant's identity. |
| Background Checks | Background checks are conducted through the National Crime Information Center (NCIC) to ensure the applicant does not have a criminal record that would disqualify them. |
| Expiration Policy | Individuals must return their ID cards when they expire or if their employment is terminated for any reason. |
| Final Determination | The Base Commanding Officer has the final authority to grant or deny access based on the information provided in the form. |
Secnav 5512 1: Usage Instruction
Completing the Secnav 5512 1 form is essential for gaining access to Department of Defense installations. Following these steps will help ensure that the form is filled out correctly, allowing for a smoother processing experience.
- Start with the applicant's personal information. Fill in your last name, first name, and middle name. If applicable, include a name suffix such as Jr., Sr., etc.
- Indicate your Hispanic or Latino status and select your race from the provided options.
- Select your gender and provide your date of birth, city of birth, state of birth, and birth country.
- Mark your U.S. citizenship status and provide details if you have dual citizenship.
- List the identity source and fill in the document number along with the issuing authority and issue/expiration dates.
- Provide your weight, height, hair color, and eye color.
- Enter your home address and home phone number.
- Fill in the base sponsor's name and sponsor phone number.
- Provide your employer's name and address along with the employer phone number.
- Include your supervisor's name and address and their phone number.
- Indicate your work hours and work days by checking the appropriate boxes.
- Answer the question regarding prior felony convictions and initial the box.
- Initial the statement regarding the requirement to return your Local Population ID card.
- Sign and date the form, confirming the accuracy of your statements.
After submitting the form, the Base Commanding Officer will review it for approval. This process includes verification of the information provided and may involve additional checks for security purposes.
Learn More on Secnav 5512 1
What is the purpose of the SECNAV 5512/1 form?
The SECNAV 5512/1 form is used to control physical access to Department of Defense (DoD) and Department of the Navy (DON) installations. It helps identify individuals seeking access by verifying their identity through biometric databases and associated data processing services. The form also facilitates the issuance of identification badges, tracks entry and exit times, and maintains visitor statistics.
Who needs to fill out the SECNAV 5512/1 form?
Individuals who require access to DoD or DON facilities must complete the SECNAV 5512/1 form. This includes employees, contractors, and visitors who need to enter restricted areas. The form collects essential personal information to ensure the safety and security of the installations.
What information is required on the SECNAV 5512/1 form?
The form requires various personal details, including:
- Full name (last, first, middle)
- Date of birth
- Place of birth
- Citizenship status
- Gender
- Physical characteristics (weight, height, hair color, eye color)
- Home address and contact information
- Employment details
- Any prior felony convictions
This information is necessary for identity proofing and to assess eligibility for access.
What happens if I do not provide the requested information?
Providing information on the SECNAV 5512/1 form is voluntary; however, failure to complete the form may result in denied access to DoD facilities and associated benefits. It is crucial to provide accurate and complete information to avoid any issues with access approval.
How is the information on the SECNAV 5512/1 form protected?
The information collected on the SECNAV 5512/1 form is treated as privileged and confidential. It is protected under the Privacy Act, and unauthorized disclosure may lead to both criminal and civil penalties. The form includes a privacy statement that outlines the purpose of data collection and the measures taken to safeguard personal information.
Who has the final authority on access decisions?
The Base Commanding Officer holds the final authority for determining access to DoD-controlled installations. Their decision is based on the information provided in the SECNAV 5512/1 form and the results of any background checks performed, including checks against the National Crime Information Center (NCIC) and other relevant databases.
Common mistakes
Completing the Secnav 5512 1 form can be a daunting task, and many individuals make common mistakes that can lead to delays or even denial of access. One frequent error is failing to provide complete information. Each section of the form requires specific details, and leaving any part blank can raise red flags. It is crucial to double-check that all fields are filled out accurately.
Another mistake is not updating personal information. For instance, if a person has recently changed their name due to marriage or divorce, this change must be reflected on the form. Neglecting to do so may result in complications during the verification process.
Many applicants also overlook the importance of providing accurate citizenship information. Misrepresenting one's citizenship status can lead to serious consequences, including legal repercussions. It is essential to answer the citizenship questions honestly and provide the required documentation to support your claims.
Additionally, some individuals fail to read the instructions carefully. The Secnav 5512 1 form includes specific guidelines on how to fill out each section. Ignoring these instructions can result in errors that could have been easily avoided. Taking the time to understand the requirements can save significant hassle later.
Not providing the necessary identification documentation is another common pitfall. Each type of citizenship—whether by birth, naturalization, or derived—requires different supporting documents. Failing to include these documents can lead to delays in processing the application.
Inaccurate or incomplete contact information is another frequent issue. Applicants sometimes provide outdated phone numbers or addresses, making it difficult for officials to reach them if there are questions or concerns regarding their application. Always ensure that contact details are current and correct.
Some applicants also neglect to sign the form. A signature is a critical component, as it confirms that the applicant has reviewed the information and asserts its accuracy. Without a signature, the form may be deemed invalid.
Another common mistake is misunderstanding the felony conviction question. Some individuals may believe that minor offenses do not need to be disclosed. However, all felony convictions must be reported, regardless of how long ago they occurred. Transparency is key to a successful application.
Finally, many applicants fail to keep a copy of their completed form. Having a personal record can be invaluable if there are any issues or questions later on. It serves as a reference point and can help clarify any discrepancies that may arise during the processing of the application.
By being aware of these common mistakes and taking the time to fill out the Secnav 5512 1 form carefully, individuals can enhance their chances of a smooth and successful application process.
Documents used along the form
The SECNAV 5512/1 form is essential for individuals seeking access to Department of Defense installations. However, several other documents often accompany this form to ensure thorough vetting and compliance with security protocols. Below is a list of these related documents, each serving a specific purpose in the access control process.
- Form I-9: This form is used to verify the identity and employment authorization of individuals hired for employment in the United States. It requires information about the employee's identity and eligibility to work.
- National Crime Information Center (NCIC) Check: This is a background check that queries the NCIC database to determine if an individual has any criminal records or outstanding warrants. It is a crucial step in the vetting process.
- Visitor Access Request Form: This document is often used by individuals who do not have a permanent ID card but need temporary access to a military installation. It collects necessary information to assess the visitor's eligibility.
- Department of Defense (DoD) Security Clearance Form: This form is required for individuals seeking access to classified information or facilities. It collects personal history and background information to evaluate security risks.
- Release of Information Authorization: This document allows the DoD to obtain personal information from various sources, such as law enforcement agencies, to verify the applicant's background and suitability for access.
Each of these documents plays a vital role in maintaining security and ensuring that only authorized individuals gain access to sensitive areas. Understanding their functions helps clarify the comprehensive nature of the vetting process in military installations.
Similar forms
The SECNAV 5512/1 form is similar to the Department of Defense (DoD) Form 2875, which is used for system access requests. Both documents serve the purpose of controlling access to sensitive areas and information. The DoD Form 2875 requires individuals to provide personal information and justification for access, similar to how the SECNAV 5512/1 collects identity proofing details. Each form also emphasizes the importance of accurate information, as discrepancies can lead to access denial.
Another document comparable to the SECNAV 5512/1 is the Common Access Card (CAC) application. The CAC serves as an identification card for military personnel, civilians, and contractors, granting them access to DoD facilities. Like the SECNAV 5512/1, the CAC application involves verifying identity and eligibility through personal information and documentation. Both forms are critical in maintaining security within military installations and ensuring that only authorized individuals can gain entry.
The Visitor Access Request (VAR) form also shares similarities with the SECNAV 5512/1. This form is used to request access for visitors to military installations. It requires the submission of personal information and the purpose of the visit, akin to the identity verification process outlined in the SECNAV 5512/1. Both documents are essential for tracking and managing who enters secure areas, thereby enhancing overall security protocols.
Additionally, the Department of Homeland Security (DHS) Form I-9, used for employment eligibility verification, parallels the SECNAV 5512/1 in that it requires individuals to provide identification and proof of eligibility. Both forms seek to ensure that only authorized individuals are granted access, whether to a job site or a military installation. The emphasis on accurate documentation and identity verification in both forms is crucial for maintaining security and compliance with federal regulations.
Lastly, the Federal Bureau of Investigation (FBI) background check form is relevant in this context. This document is utilized to conduct background checks on individuals seeking access to sensitive government positions. Similar to the SECNAV 5512/1, the FBI background check form requires detailed personal information and consent for information sharing. Both documents play a vital role in assessing the trustworthiness of individuals seeking access to secure environments, thereby safeguarding national security interests.
Dos and Don'ts
When filling out the SECNAV 5512/1 form, there are important guidelines to follow. Below is a list of things you should and shouldn't do:
- Do ensure accuracy: Double-check all information before submission to avoid delays or denial of access.
- Do provide complete documentation: Include all necessary identification and supporting documents as specified.
- Do sign and date: Ensure your signature is present to validate the form.
- Do keep a copy: Retain a copy of the completed form for your records.
- Don't leave fields blank: Fill in all required fields to prevent processing issues.
- Don't provide false information: Misrepresentation can lead to legal consequences and denial of access.
- Don't forget to review: Check the form for completeness and accuracy before submitting.
- Don't submit without understanding: Make sure you comprehend all sections of the form to avoid mistakes.
Misconceptions
Understanding the SECNAV 5512/1 form is crucial for those seeking access to Department of Defense installations. However, several misconceptions often arise regarding this form. Here are four common misunderstandings:
- Misconception 1: The form is only for military personnel.
- Misconception 2: Providing personal information is mandatory.
- Misconception 3: The form guarantees access to installations.
- Misconception 4: The form is only needed once.
This is incorrect. The SECNAV 5512/1 form is used by civilians, contractors, and visitors as well. Anyone needing access to Department of Defense facilities must complete this form.
While the form requests various personal details, providing this information is technically voluntary. However, not supplying the required information may lead to denial of access.
Filling out the SECNAV 5512/1 does not guarantee access. The final decision rests with the Base Commanding Officer, who has the authority to grant or deny access based on the information provided.
This is a misconception as well. The SECNAV 5512/1 form must be updated regularly, especially if there are changes in personal circumstances, such as a name change or a change in employment.
Key takeaways
When filling out and using the SECNAV 5512/1 form, there are several important points to consider:
- Purpose of the Form: The SECNAV 5512/1 form is designed to control access to Department of Defense (DoD) installations and facilities. It helps verify an individual's identity through biometric databases.
- Voluntary Disclosure: Providing information on the form is voluntary. However, not supplying the requested details may lead to denial of access to benefits and DoD installations.
- Identity Proofing: Applicants must present valid identification documents, such as a Social Security number or state ID. Different requirements exist for U.S. citizens, naturalized citizens, and aliens.
- Felony Convictions: The form includes a question regarding prior felony convictions. Applicants must answer truthfully, as false statements can lead to legal penalties.
- Final Authority: The Base Commanding Officer holds the final authority for granting access to DoD installations. Their decision is based on the information provided and the results of background checks.
Completing this form accurately is essential for ensuring proper access to military facilities.