Miami Airport Badge Application Form – Fill Out and Use This PDF

Are you planning to work with Miami International Airport? If so, you will need to complete the Miami Airport Badge Application Form. This form outlines essential information that is necessary to assess your level of eligibility. With comprehensive details, our dedicated Airport Security Team can assess qualifications quickly, easily and accurately. Ensuring safety is our number one priority in protecting both airport personnel and passengers. Additionally, this badge settles licensing requirements when undertaking Authorized Agent Duties. Submitting this application will bring you one step closer towards entering one of the highest regarded airports in the nation!

Miami Airport Badge Application Form PDF Details

Are you looking to obtain a badge from the Miami International Airport? The application form is straightforward and easy-to-follow, but it can be difficult for those who are unfamiliar with the process. In this blog post, we’ll provide an overview of what you need to know about applying for an airport badge in Miami to make sure your application is successful. Whether you’re an aspiring transportation executive or just making a one-time trip through the MIA Airport, we'll provide all the step-by-step details on how to apply plus helpful tips so that your application experience runs as smoothly as possible. Let's get started!

Question	Answer
Form Name	Miami Airport Badge Application Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	mia access control form, mia access form pdf, miami international airport badge, mia access control form pdf

Form Preview Example

SECURITY DIVISION – CREDENTIALING SECTION Terminal D, 3rd floor

Miami-Dade Aviation Department

Post Office Box 025504 AMF, Miami, Florida 33102 (305) 876-7188

AIRPORT IDENTIFICATION BADGE APPLICATION

All areas must be completed upon submission and must be typed. Signatures by the employee and authorized company representatives will only be accepted using blue ink. The Miami-Dade Aviation Department (MDAD) will not accept this form if it is altered (including use of correction fluid), torn, folded, bent or otherwise defaced. The application must be processed within two weeks of the date it is signed by the authorized company representative (s).

Section I-Applicant Information			Social Security Number:

	First Name:		Middle Name:		Last name:

	Date of Birth:		Job Title:			Height: _____		Hair color: ____	Sex: M F
	(MM/DD/YYYY)					Weight: _____		Eye color: ____	Race: _____

	Home Address (incl. City/State/Zip):						Phone Number:

		Other Names Used (Including Maiden name and any aliases)
	FIRST NAME			MIDDLE NAME				LAST NAME

(1)Every Applicant must present two forms of unexpired identification bearing the same name issued by a government authority and at least one of which must have a photo. Acceptable forms of identification are those listed in the table below.

(2)For U.S. Citizens, two forms of ID as described in paragraph (1) if no ID from List A, you must provide one ID from List B and one ID from List C in the table below.

(3)For U.S. Citizens born abroad or naturalized U.S. Citizens, have at least one of the following: (i) U.S. Passport, (ii) Certification of Naturalization, or (iii) Certificate of Birth Abroad (Form DS-1350 or Form FS-545).

(4)For Individuals who hold a non-immigrant visa, provide the visa control number.

(5)For Individuals who are not U.S. Citizens, have at least one of the following; (i) Permanent Resident Card or Alien Registration Receipt Card (Form I-551), (ii) Arrival-Departure Record (Form I-94) when presented with an unexpired foreign passport bearing the same name and containing an endorsement of the individual’s non-immigrant status.

List A

ard _____________Exp._____

-Immigrant Visa and I-94#_________________

-551 Stamp: Country______

#______________________________ Exp. ________

		List B	AND		List C
		ense: State_______
	# _____________________________				issued by a State,
	# _____________________________

				County, Municipal Authority, or US
				County, Municipal Authority, or US
OR	gov’t agencies with photo			Territory
	gov’t agencies with photo
	#____________________Exp.______

				Birth (FS-545) _______________
				Birth (FS-545) _______________




	#____________________ Exp._______			(DS-1350) __________________
	#____________________ Exp._______

Country of Birth:

Country of Citizenship:

CUSTOMS AND BORDER PROTECTION ONLY

CBP Approval Signature: ______________________ (BLUE INK ONLY) Approval Date:

Comments:_____________________________

****FOR MDAD ACCESS CONTROL OFFICE USE ONLY****

SIDA Training Date:

Badge Number:

Badge Access Level:

Date Issued:

Expiration Date:

Applicant’s

Initials

ID Processed By:

Reason for GU/Reprint:

GU/Reprint approved by:

	CREDENTIALING SECTION PAYMENT				VETTING APPROVAL

Date: ___________________		Company Code: ________________			MIA CHRC Identifier: _____________________
Payment Type:	CHRC / ID	CHRC	ID	Lost Badge #:_______________	CHRC Processor: _______________________
					CHRC Processor: _______________________
Receipt #: ___________________		__________________	_________________	___________________	CHRC Case #: __________________________
Receipt #: ___________________		__________________	_________________	___________________
B	M C A N	B M C A N	B M C A N	B M C A N	CHRC Received Date #: ___________________
REPLACEMENT (N/C) REASON ________________________________________________________________					STA Approved: Yes No Date:__________________


MIA ACCESS CONTROL FORM					March 2018 - 1
Page 1 of 4

Section II- Applicant’s Criminal History (Must check “Yes” or “No” for each item listed)

Persons seeking unescorted access to the Security Identification Display Areas (SIDA) or Sterile Areas of an airport and individuals performing security checkpoint screening functions at an airport and their supervisors are subject to the requirements of Title 49 of the Code

of Federal Regulations, Parts 1542.209 or 1544.229. These requirements include a Criminal History Records Checks (CHRC). Indicate below, by checking “Yes” or “No” for each item listed, if you have ever pleaded guilty or nolo contendere (“no contest”), had adjudication

withheld, been convicted or found not guilty by reason of insanity to any of the following:

Yes

Forgery of certificates, false marking of aircraft, and other aircraft

Yes

Aircraft piracy

registration violations

Yes

Interference with air navigation

Yes

Murder

Yes

Improper transportation of a hazardous material

Yes

Assault with intent to murder

Yes

Felony involving violence at International Airports

Yes

Espionage

Yes

Interference with flight crew members or flight attendants

Yes

Sedition

Yes

Commission of certain crimes aboard aircraft in flight

Yes

Kidnapping or hostage taking

Yes

Carrying a weapon or explosive aboard an aircraft

Yes

Treason

Yes

Conveying false information and threats

Yes

Rape or aggravated sexual abuse

Yes

Unlawful possession, use, sale, distribution or manufacture of an

Yes

Extortion

explosive or weapon

Yes

Lighting violations involving transporting controlled substances

Yes

Felony arson

Yes

Unlawful entry into an aircraft or airport area that serves air

Yes

Distribution of or intent to distribute a

carriers or foreign air carriers contrary to established security

controlled substance

requirements

Yes

Destruction of an aircraft or aircraft facility

Yes

Armed or felony unarmed robbery

Yes

Aircraft piracy outside the special aircraft jurisdiction of the United

Yes

Felony involving dishonesty, fraud, or

States

misrepresentation

Yes

Felony involving possession or distribution of stolen property

Yes

Felony involving a threat

Yes

Felony involving willful destruction of property

Yes

Felony involving aggravated assault

Yes

Felony involving importation or manufacture of a controlled

Yes

Felony involving bribery

substance

Yes

Felony involving burglary

Yes

Felony involving theft

Yes

Felony involving the illegal possession of a controlled substance

Yes

Conspiracy or attempt to commit any

punishable by a maximum term of imprisonment of more than 1

of the criminal acts listed on this

year

TABLE

The MDAD Airport Security Coordinator keeps confidential the criminal history record obtained from the FBI and uses it only for determining whether to issue an Airport Identification Badge (ID Badge). You may get a copy of your criminal history record sent by the FBI to the Airport Security Coordinator by submitting a written request within 30 days after being advised that your criminal history shows you are disqualified from being issued an ID Badge. If you believe that any information is inaccurate, you may directly contact the agency that reported the disqualifying conviction to correct your record.

I understand that I have a continuing obligation under Title 49, CFR, Parts 1542.209 or 1544.229 to disclose to the airport operator within 24 hours if I plead guilty or nolo contendere (“no contest”) to, have an adjudication withheld, been convicted or found not guilty by reason of insanity to any of the disqualifying

crimes listed on this application or the federal security regulations.

Privacy Act Notice: Authority: 6 U.S.C. § 1140,46 U.S.C. § 70105; 49 U.S.C. §§ 106, 114, 5103a, 40103 (b) (3), 40113, 44903, 44935-44936, 44939, and 46105; the Implementing Recommendations of the 9/11 Commission Act of 2007, § 1520 (121 Stat. 444, Public Law 110-52, August 3, 2007); and Executive Order 9397, as amended.

Purpose: The Department of Homeland Security (DHS) will use the biographic information to conduct a security threat assessment. Your fingerprints and associated information will be provided to the Federal Bureau of Investigation (FBI) for the purpose of comparing your fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or its successor systems including civil, criminal, and latent fingerprint repositories. The FBI may retain your fingerprints and associated information in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. DHS will also transmit your fingerprints for enrollment into the US-VISIT Automated Biometrics Identification System (IDENT). If you provide your Social Security Number (SSN), DHS may provide your name and SSN to the Social Security Administration (SSA) to compare that information against SSA records to ensure the validity of the information.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C. 522a(b) of the Privacy Act, all or a portion of the records or information contained in this system may be disclosed outside DHS as a routine use pursuant to 5 U.S.C. 522a(b)(3) including with third parties during the course of a security threat assessment, employment investigation, or adjudication of a waiver or appeal request to the extent necessary to obtain information pertinent to the assessment, investigation, or adjudication of your application or in accordance with the routine uses identified in the TSA system of records notice (SORN) DHS/TSA 002, Transportation Security Threat Assessment System. For as long as your fingerprints and associated information are retained in NGI,

your information may be disclosed pursuant to your consent or without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses for the NGI system and FBI’s Blanket Routine Uses.

Disclosure: Furnishing this information (including your SSN) is voluntary; however, if you do not provide your SSN or any other information requested, DHS may be unable to complete your application for a security threat assessment. MDAD has advised me of the purpose, disclosure and uses for submitting my personal information to the Credentialing Section when requesting MDAD issued ID badge media as per Transportation Security Administration (TSA) Security Directive 1542-04-08 series.

MIA ACCESS CONTROL FORM

March 2018 - 1

Page 2 of 4

Section III-Applicant’s Certification

I hereby submit to MDAD Identification Section (Credentialing Section) this application for an ID Badge and agree to the following:

1.To comply at all times with the security rules and policies of MDAD, including the provisions of Chapter 25 and the Transportation Security Administration (TSA), an agency of the United States, including the provisions of Title 49, CFR, Parts 1540,1542, and 1544.

2.All ID Badges remain the property of MDAD; My ID Badge cannot be transferred to another individual or used for any purpose by

another individual; I will visibly display my ID Badge outside my garments on my upper body whenever I am in any area of the airport; I will not aid nor participate in “piggy-backing” (allowing unauthorized access to secure or restricted areas) nor will I otherwise breach, disobey or disregard any security directive, plan or program at the airport; I will challenge any person who enters a secured/restricted area if the person does not properly display an ID Badge. If the person I challenge cannot produce a valid ID Badge, I will immediately notify the Miami-Dade Police Department or the MDAD at (305) 876-0385.

3.Use of the ID Badge constitutes consent to search and monitoring at any area of the airport.

4.MDAD reserves the right to revoke authorization for an ID Badge where such action is determined to be in the best interest of airport security. You must immediately return the ID Badge to MDAD Credentialing Section or your employer upon notification that your authorization has been revoked; I will immediately notify my Supervisor or MDAD of any unattended bags and or suspicious activity; I will immediately notify my employer if my ID Badge is lost or stolen. A non-refundable fee of $75.00 will be assessed for the first replacement and $100.00 for the second replacement within 24 months of original issuance. There will not be a replacement issued for a third time within 24 months of original issuance. The Security Credentialing Section will collect the fee before a replacement ID Badge is issued. Furthermore, a replacement ID Badge may only be issued if I declare in writing that the ID Badge has been lost, stolen, or destroyed. The ID Badge is the property of MDAD. You must immediately return your ID

Badge to your employer or the MDAD Credentialing Section at the end of employment or upon receiving notification that your MDAD ID Badge is being revoked. The MDAD ID Office will issue a receipt as proof of ID Badge return. Failure to comply within 24 hours is in direct violation of the Airport Security Program ASP and you can be subject to a potential $10,000 Civil Penalty Fine assessed by the Transportation Security Administration TSA under title 49 of the Code of Federal Regulations CFR Part 1540.105; 49 USC 46301.

5.In the event of any change in my employee status (i.e. transfer, job title), I will obtain a new ID Badge noting the change and return the original ID Badge.

6.I will immediately notify MDAD and/or my Supervisor if I am arrested of any of the crimes listed under Title 49, CFR, Parts 1542.209 or 1544.229.

7.Contractor Identification Badges are valid only within the construction site to which I am assigned by my employer, within those areas authorized by MDAD and only until the contract is closed out and/or terminated, suspended.

I understand and agree to comply with the terms and conditions provided for in this application and agree to comply with any changes or amendments to the terms and conditions that may be imposed by MDAD. The information that I have provided on this application is true, complete, and correct to the best of my knowledge and belief and is provided in good faith. I understand that a knowing and willful false statement on this application can be punished by fine or imprisonment or both. (See Section 1001, of Title 18 United States Code); (See also Title 49 of the Code of Federal Regulations, Sections 1540.103 and 1542.209)

I authorize the Social Security Administration to release my Social Security Number and full name to the Transportation Security Administration (TSA), Office of Intelligence and Analysis (OIA), Attention: Aviation Programs (TSA-10) Aviation Worker Program, 601 South 12th Street, Arlington, VA 20598.

I am the individual to whom the information applies and want this information released to verify that my SSN is correct. I know that if I make any representation that I know is false to obtain information from Social Security records, I could be punished by a fine, imprisonment, or both.

Applicant’s Name ______________________________ Social Security ___________________ Date of Birth ______________

Applicant’s Signature ____________________________________________Date_______________________

(SIGN IN BLUE INK ONLY)

MIA ACCESS CONTROL FORM

March 2018 - 1

Page 3 of 4

Section IV – Access Requirements (to be completed by the employer)

Check all of the following that apply:

____ New Applicant ____ Renewal/Replacement ____ Lost Badge ____ Damaged Badge ____ Federal & Local Law Enforcement

Badge Type

Check the one that applies:

____	Green & Brown	____	Green	____	White with Concourse Access	____	Blue
(Ramp & Cargo Access)		(Ramp	Access only)	(Sterile	Concourse Access)	(MDAD Employee)

____ White

(Terminal Public Access)

____	Brown & Green	____	Brown	____	Lime & Orange
(Cargo & Ramp Access)		(Cargo Access only)		(Cargo	Warehouse only)

____ Yellow

(Contractor)

____ White & Blue

(AOA Delivery Escort Required)

Special Certifications:

____		CBP Seal	____	Extended Ajar
(CBP Approval Required)			(Letter Required)

____	Escort Authority		____	LEO
(Letter Required)		(Letter Required)

Section V - Employer’s Certification

I certify that this applicant is a direct employee of the company I represent and all information provided by or on behalf of the Employer is true, accurate, and complete. I certify that: (1) I have verified the applicant’s identity by reviewing at least two forms of identification (one of which bears the applicant’s photograph); (2) the applicant has presented to the representative signed below that he or she ha s not been

convicted of a crime identified in 49 CFR 1542.209 or 1544.229; (3) The Employer will immediately report to MDAD Credentialing Section any information that becomes available to us indicating that the applicant was arrested, indicted or convicted of one of the crimes identified

in 49 CFR 1542.209 or 1544.229; (4) The ID Badge is the property of MDAD. The employer will immediately notify and return the employee’s ID Badge to the MDAD Credentialing Section if the employee’s employment is terminated, contract work at the Airport is completed or the employee’s ID Badge is being revoked. Failure to notify MDAD within 24 hours, collect and return the employee’s ID Badge to the MDAD Credentialing Section can subject the employer to a Civil Penalty of up to $10,000, assessed by

the Transportation Security Administration TSA in accordance with title 49 of the United States Code Service 49 USC 46301 (a) (6);

(5)The Employer will immediately notify MDAD Credentialing Section if the applicant’s ID Badge is reported as being lost or stolen and; (6) I certify that the Employer has complied with, and will continue to comply with the provisions of Title 49, CFR, Parts 1540, 1542, and 1544. I also certify that the Employer will inform MDAD Credentialing Section if either of the following applies:

(i)the applicant was unable to support statements made on the application form;

(ii)there are significant inconsistencies in the information provided on the application; or

(iii)information has become available to us indicating a possible conviction of the crime(s) listed in 49 CFR 1542. 209 or 1544.229

I have read and understand the potential penalties described in this application for providing false or misleading information or failing to report as required.

Company Name: ________________________________________	Company Code: ________________________
Mailing Address: ________________________________________________________________________________
Telephone Number: (________)______________________ Email Address: _________________________________
Authorized Representative: _______________________________________		Title: __________________________
(Print Name)
Authorized Representative’s Signature: _____________________________		Date: __________________________
(SIGN IN BLUE INK ONLY)		(APPLICATION EXPIRES 2 WEEKS FROM THIS DATE)

NOTE: SIGNATURE MUST BE ORIGINAL IN BLUE INK. NO COPIES/STAMPS WILL BE ACCEPTED.

MIA ACCESS CONTROL FORM	March 2018 - 1
Page 4 of 4

How to Edit Miami Airport Badge Application Form Online for Free

airport identification badge can be filled in without any problem. Just make use of FormsPal PDF tool to do the job right away. The editor is continually updated by us, receiving new awesome functions and turning out to be much more versatile. Getting underway is simple! Everything you should do is stick to the following simple steps directly below:

Step 1: Access the PDF file in our editor by hitting the "Get Form Button" in the top area of this webpage.

Step 2: When you open the tool, you will notice the document all set to be filled in. In addition to filling out different blanks, you can also do other things with the Document, including adding custom text, changing the initial textual content, adding illustrations or photos, affixing your signature to the form, and much more.

This form requires specific information to be filled in, hence be certain to take whatever time to type in what's required:

1. First of all, when filling in the airport identification badge, beging with the page that includes the following fields:

airport badge application writing process described (portion 1)

2. The subsequent part is to complete the next few fields: ard Exp, Immigrant Visa and I, Stamp Country, Exp, govt agencies with photo Exp, Exp, County Municipal Authority or US, Birth FS, Country of Birth, Country of Citizenship, CBP Approval Signature BLUE INK, CUSTOMS AND BORDER PROTECTION ONLY, SIDA Training Date, Badge Number, and Badge Access Level.

Stage number 2 for submitting airport badge application

You can potentially make an error while filling out your Country of Birth, and so make sure that you reread it prior to when you send it in.

3. The next part is going to be easy - complete all of the fields in Persons seeking unescorted access, Yes, Forgery of certificates false, Yes, Aircraft piracy, Yes, No Murder, Improper transportation of a, Interference with flight crew, No No Commission of certain crimes, Yes Yes, Yes Yes Yes Yes, No No, Assault with intent to murder, and Sedition Kidnapping or hostage in order to complete the current step.

Forgery of certificates false, Yes, and No Murder of airport badge application

4. Your next paragraph needs your information in the following places: I understand and agree to comply, MIA ACCESS CONTROL FORM Page of, and March. It is important to provide all needed info to move further.

airport badge application conclusion process clarified (step 4)

5. As you approach the final parts of this form, there are a few more things to complete. Mainly, Section IV Access Requirements to, New Applicant RenewalReplacement, Badge Type, Check the one that applies Green, Lime Orange Yellow White Blue, Special Certifications CBP Seal, Escort Authority, Extended Ajar, LEO, and I certify that this applicant is a should be filled out.

Filling out part 5 of airport badge application

Step 3: Reread the information you've inserted in the form fields and press the "Done" button. Make a 7-day free trial account with us and get direct access to airport identification badge - accessible in your personal account. We do not sell or share any details that you enter when completing documents at our website.

Miami Airport Badge Application Form – Fill Out and Use This PDF

Miami Airport Badge Application Form PDF Details

Form Preview Example

How to Edit Miami Airport Badge Application Form Online for Free

Miami Airport Badge Application Form isn’t the one you’re looking for?

Related Documents