.
Ship Name:
Ship Flag: MSC/EPIC FORCE PROTECTION CREWLIST SUBMISSION TEMPLATE (Revision 5 - 09AUG2006)
FOUO-PRIVACY SENSITIVE. ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Submission Date:
EMAIL SUBJECT LINE to read: EPIC - PM[#] [PM POC (f irst 3 letters)] - [SHIP NAME] - [list TY PE (ie CREW, CONTractors, etc)].
Submitted by: Examples: EPIC - PM5 HUR - WRATH - CREW ; EPIC - MSFSC JON - DEIHL - CONT
AUTHORITY: SECNAVINST 5211.5D, E0 9397. PRIVACY ACT STATEMENT (1974)
PRINCIPAL PURPOSE(S): To enable USCG and DOJ to screen personnel with unrestricted access to MSC personnel facilities, resources and/or DOD cargo over which MSC has control against relevant databases.
ROUTINE USE(S): The information will be used to ensure Force Protection of MSC and DOD personnel and assets, and may be furnished to other Navy personnel or other components of DOD who have a need for the Information in the performance of their duties.
DISCLOSURE: Voluntary; however, failure to provide information may affect clearance to work under MSC contracts.
LAST NAME 1 LAST NAME 2 FIRST NAME MIDDLE NAME DATE OF SSN PASSPORT NATIONALITY RATING or MISC INFO
(no spaces, no dashes) (leave blank if (complete with (NMN - if no BIRTH (no spaces, NUMBER (Country listed POSITION
not applicable) no initials) middle name) (MMDDYYYY) no dashes) (no spaces, on Passport) (if applicable)
no dashes)
0 /SAMPLE SMITH ROBERT NMN 12301981 % MISC SN 123456789 $ 123456789 USA AB Pre-employment screening
1 /SUBJECT % MISC SN $
2 /SUBJECT % MISC SN $
3 /SUBJECT % MISC SN $
4 /SUBJECT % MISC SN $
5 /SUBJECT % MISC SN $
6 /SUBJECT % MISC SN $
7 /SUBJECT % MISC SN $
8 /SUBJECT % MISC SN $
9 /SUBJECT % MISC SN $
10 /SUBJECT % MISC SN $
11 /SUBJECT % MISC SN $
12 /SUBJECT % MISC SN $
13 /SUBJECT % MISC SN $
14 /SUBJECT % MISC SN $
15 /SUBJECT % MISC SN $
16 /SUBJECT % MISC SN $
17 /SUBJECT % MISC SN $
18 /SUBJECT % MISC SN $
19 /SUBJECT % MISC SN $
20 /SUBJECT % MISC SN $
21 /SUBJECT % MISC SN $
22 /SUBJECT % MISC SN $
23 /SUBJECT % MISC SN $
24 /SUBJECT % MISC SN $
25 /SUBJECT % MISC SN $
26 /SUBJECT % MISC SN $
27 /SUBJECT % MISC SN $
28 /SUBJECT % MISC SN $
29 /SUBJECT % MISC SN $
30 /SUBJECT % MISC SN $
31 /SUBJECT % MISC SN $
32 /SUBJECT % MISC SN $
33 /SUBJECT % MISC SN $
34 /SUBJECT % MISC SN $
35 /SUBJECT % MISC SN $
36 /SUBJECT % MISC SN $
37 /SUBJECT % MISC SN $
38 /SUBJECT % MISC SN $
39 /SUBJECT % MISC SN $
40 /SUBJECT % MISC SN $
41 /SUBJECT % MISC SN $
42 /SUBJECT % MISC SN $
43 /SUBJECT % MISC SN $
44 /SUBJECT % MISC SN $
45 /SUBJECT % MISC SN $
46 /SUBJECT % MISC SN $
47 /SUBJECT % MISC SN $
48 /SUBJECT % MISC SN $
49 /SUBJECT % MISC SN $
50 /SUBJECT % MISC SN $
51 /SUBJECT % MISC SN $
52 /SUBJECT % MISC SN $
53 /SUBJECT % MISC SN $
54 /SUBJECT % MISC SN $
55 /SUBJECT % MISC SN $
56 /SUBJECT % MISC SN $
57 /SUBJECT % MISC SN $
58 /SUBJECT % MISC SN $
59 /SUBJECT % MISC SN $
60 /SUBJECT % MISC SN $
.