Portland Form 371 PDF Details

Navigating the intricacies of the Portland 371 form, a comprehensive documentation required for Security Badge Renewal, demands a clear understanding of its purpose, requirements, and the implications of the information provided by applicants. This form is essential for employees seeking the renewal of their Portland-based security badges, a critical component for those working within secured areas, as these badges grant access to otherwise restricted zones. It meticulously collects personal and employment-related data, including full legal name, mailing address, phone number, and company affiliation, underscoring the significance of accuracy in its completion. Employees are called upon to declare the veracity of their submitted information under penalty of fine or imprisonment for falsehoods, highlighting the seriousness with which this process is treated. Moreover, it facilitates a rigorous background check, necessitating an authorization for the Social Security Administration to release the applicant’s Social Security Number and full name to relevant transportation and security authorities. This process is designed not only to verify the correctness of an SSN but also to ensure that the applicant does not pose a security threat, involving checks against criminal histories and more. The document underscores the importance of submitting valid identification and employment eligibility proofs, specifying acceptable documents. This includes, but is not limited to, U.S. passports, Permanent Resident Cards, and various forms that establish both identity and employment eligibility. It’s a tiered system that ensures only eligible individuals access sensitive airport areas, thus safeguarding national security while maintaining operational integrity within transport hubs. The form is a testament to the layered security measures in place, reminding applicants of the extensive review process their application will undergo and the critical nature of the information they provide.

QuestionAnswer
Form NamePortland Form 371
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesFS-545, pdx badging, I-551, I-94A

Form Preview Example

PDX Security Badge Renewal Application

Office Use Only

Badge Staff Initials

Badge #

Employee Full Name:

 

 

 

Last

 

 

First

Middle (Full)

Employee Mailing Address:

 

 

 

 

 

 

 

City:

 

 

State:

 

Zip Code:

 

Phone Number:

 

Company:

 

 

 

 

 

 

 

Certifications

The information I have provided 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 can be punished by ine or imprisonment or both (see Section 1001 of Title 18 of the United States Code).

I authorize the Social Security Administration to release my Social Security Number and full name to the Transportation Security Administration, Oice of Transportation Threat Assessment and Credentialing (TTAC), Attention: Aviation Programs (TSA-19)/Aviation Worker Program, 601 South 12th Street, Arlington, VA 22202.

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 ine or imprisonment or both.

Privacy Act Notice

Authority: 49 U.S.C. ¶114, 44936 authorizes the collection of this information.

Purpose: The Department of Homeland Security (DHS) will use the biographical information to conduct a security threat assessment and will forward any ingerprint information to the a Federal Bureau of Investigation to conduct a criminal history records check of individuals who are applying for, or who hold, an airport-issued identiication media or who are applying to become a Trusted Agent of the airport operator. DHS will also transmit the ingerprints for enrollment into the US-VISIT’s Automated Biometrics Identiication 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’s records to ensure the validity of your name and SSN.

Routine Uses: This information may be shared 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 identiied in the Transportation Security Threat Assessment System (T-STAS), DHS/TSA 002.

**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 identiication media.

Employee Signature:

 

Date:

 

 

 

 

 

Form 371 1-14

Page 1 of 2
DOCUMENT # FROM LIST B:
Driver’s license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
ID card issued by Federal, State, or local government agency or entity provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

ALL Applicants

*Required

* Name

 

* Country of Citizenship

 

 

 

 

 

 

 

 

 

 

* Date of Birth

 

** Social Security #

 

* Place of Birth

(See disclosure on reverse page)

* Gender M

 

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-US Citizens

Alien Registration # or

I-94 Arrival/Departure Form # *Non-Immigrant Visa #

(*If Issued, must provide #)

US Citizen Born Abroad

or

Naturalized US Citizen

US Passport #

or

Certiicate of Naturalization #

or

DS-1350 (Certiication of Birth Abroad) FS-240 / FS-545

Applicant must present a document from list A or both B & C All applicants must present original and unexpired documents

A

Documents that Establish Both

Identity and Employment Eligibility

U.S. Passport or U.S. Passport Card

Permanent Resident Card or Alien Registration Receipt Card (Form l-551)

Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa

Employment Authorization Document that contains a photograph (Form I-766)

In the case of a non immigrant alien authorized to work for a specific employer incident to status, a foreign passport with Form I-94 or Form I-94A bearing the same name as the passport and containing an endorsement of the alien’s

non immigrant status, as long as the period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form

Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating non immigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

B

Documents that Establish Identity

School ID card with a photograph Voter’s registration card

U.S. Military card or draft record

Military dependent’s ID card

U.S. Coast Guard Merchant Mariner Card Native American tribal document

Driver’s license issued by a Canadian government authority

For persons under the age of 18 who are unable to present a document listed above:

School record or report card

Clinic, doctor, or hospital record Day-care or nursery school record

C

Documents that Establish

Employment Eligibility

Social Security Account Number card other than one that specifies on the face that the issuance of the card does not authorize employment in the United States

Certification of Birth Abroad Issued by the Department of State (Form FS-545)

Certification of Report of Birth issued by the Department of State (Form DS-1350)

Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

Native American tribal document U.S. Citizen ID Card (Form I-197)

Identification Card for Use of Resident Citizen in the United States (Form I-179)

Employment authorization document issued by the Department of Homeland Security

DOCUMENT # FROM LIST A:

DOCUMENT # FROM LIST C:

Exp. Date (if applicable):

Exp. Date (if applicable):

Exp. Date (if applicable):

The person above is approved for Security Badge Renewal

Authorized Signatory Printed Name

Authorized Signatory Signature

Documents Verified by

Badging Staff

Form 371 1-14

Page 2 of 2

How to Edit Portland Form 371 Online for Free

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This PDF requires particular info to be filled out, thus make sure you take the time to type in precisely what is expected:

1. To start off, when completing the I-551, start with the area with the following blanks:

Completing section 1 of port of portland badging office

2. Soon after this part is completed, go to enter the applicable details in these: Name, Date of Birth, Place of Birth, NonUS Citizens, Alien Registration, I ArrivalDeparture Form, NonImmigrant Visa, If Issued must provide, Required, Country of Citizenship, Social Security See disclosure, US Citizen Born Abroad, Naturalized US Citizen, US Passport Certiicate of, and FS FS.

Stage # 2 in completing port of portland badging office

3. The third stage will be hassle-free - fill in every one of the empty fields in Documents that Establish Both, Documents that Establish Identity, Identity and Employment Eligibility, that contains a photograph Form I, Registration Receipt Card Form l, US Passport or US Passport Card, Form IA indicating non immigrant, government agency or entity, State or outlying possession of, Drivers license or ID card issued, government authority, For persons under the age of who, unable to present a document, School record or report card, and Documents that Establish to complete this part.

Writing segment 3 of port of portland badging office

4. The subsequent subsection requires your information in the following areas: Document from List A, Document from List B, Document from List C, Exp Date if applicable, Exp Date if applicable, Exp Date if applicable, The person above is approved for, Authorized Signatory Printed Name, Authorized Signatory Signature, Form, Documents Verified by, Badging Staff, and Page of. Make sure that you type in all required details to go onward.

Guidelines on how to complete port of portland badging office stage 4

As for Exp Date if applicable and Exp Date if applicable, be certain you take a second look in this section. The two of these could be the most important ones in this document.

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