What is the purpose of the SECAM 5512/1?
The purpose of the form is 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 security areas of responsibility and information; to issue badges, replace lost badges, and retrieve passes upon leave; to maintain statistics of visitors; collect data to grant access to facility; and track the entry/exit times of personnel.
Is the SECAM 5512/1 accompanied by other documents?
The applicant must present documents that establish his identity and employment authorization.
How do I fill out SECAM 5512/1?
You should fill the following blocks:
- Block 1: Enter the Last Name.
- Block 2: Enter the First Name.
- Block 3: Enter the Middle Name.
- Block 4: If applicable, check the box for Name Suffix.
- Block 5: Check the applicable box for Hispanic or Latino.
- Block 6: Check the applicable box for Race.
- Block 7: Check the applicable box for Gender.
- Block 8: Enter Date of Birth.
- Block 9: Enter City of Birth.
- Block 10: Enter State of Birth.
- Block 11: Enter Country of Birth.
- Block 12: Check the applicable box for US Citizenship.
- Block 13: Enter the name of the Country of Citizenship, if you are not a US citizen.
- Block 14: You must present to the base registrar two identity documents from the list of acceptable documents listed below. Check the box for the type of Documents that will be presented as proof of identity. If the document type is not included in the list, use the rows under Other Approved Identity Source Documents to enter the type of document(s) that you will present.
- Block 15: Enter the Document Number located on the Identity Proofing Source document that was checked in Block 14.
- Block 16: Enter the State that issued the Identity Source Document.
- Block 17: Enter the Country that issued the Identity Source Document.
- Block 18: Enter the Date that the Identity Source Document was issued.
- Block 19: Enter the Date that the Identity Source Document will expire.
- Block 20: Enter Weight in pounds.
- Block 21: Enter Height in inches.
- Block 22: Check the applicable box for Hair Color.
- Block 23: Check the applicable box for Eye Color.
- Block 24: Enter Home Addresses Including City, State, Zip Code, and Home Telephone Number.
- Block 25: Enter Name of Registrant's Base Sponsor and Base Sponsor's Telephone Number.
- Block 26: Enter Employer Name and address including City, State, Zip Code, and Employer's Telephone Number.
- Block 27: Enter Supervisor's Name including City, State, Zip Code, and Supervisor's Telephone Number.
- Block 28: Check the applicable box for Work Hours or check the OTHER box and enter the work hours, check boxes for Work Days.
- Block 28: If you have been convicted of felony, check the applicable answer and enter initials.
- Block 29: Check the applicable box for felony conviction.
- Block 30: Enter initials to accept terms for returning Local Population Identification Card.
- Block 31: Sign and date the form to attest that the foregoing information is true and complete to best of your knowledge.
Where do I send the SECAM 5512/1?
Completed form should be submitted to the Base Registrar.
