Access Control Application ASA

Access Control Application

This form is to be used when applying for Access Control Permissions at Alice Springs Airport (ASA). If the valid ASIC can be coded directly or you have a current ASA issued Access Card, this will be programmed at no cost. If the ASIC cannot be coded then a separate Access Card will be provided at a charge of $20.00 inc GST.

PART 1 - TO BE COMPLETED BY APPLICANT

SECTION A - APPLICANT DETAILS

First Name *

Last Name *

Employed By *

Position *

ASIC Number *

ASIC Expiry Date *

ASIC Designation *

ASPAUS

ASIC Color *

RedGrey

ASIC Upload *

Browse

Accepted format: jpg, png, jpeg

Note: A photo of your current ASIC must be attached to this application form

Authorised Signatory *

Authorised Signatory Email *

To check who the Authorising Signatories are, and avoid any application processing delays, please contact the Airport Management Centre | call 08 8951 1211 or email asa-administration@adgnt.com.au. Applications signed by anyone other than an approved Authorising Signatory will be returned.

Date of Birth *

Gender

MaleFemaleOtherRather Not Disclose

Address *

Street address *

City *

State *

Postcode *

Email Address *

Contact Telephone Number *

PAYMENT OPTIONS

If your ASIC cannot be coded, ASA will supply an Access Card at a cost of $20.00 inc GST. Payment for Access Cards must be made at the time of submission; no application will be accepted without payment. If you have an existing ASA Access Card we will attempt to reprogram this at no cost.

Access Card with new Access Control Permissions Cost: $20.00 inc GST

ASA accepts the following methods of payment:

Cash
EFTPOS
Credit Card
Cheque made payable to Alice Springs Airport

Your Company has the option of providing ASA with an Ongoing Credit Card Authority Form that will be securely stored and used for payment each time an application is submitted. Alternatively, a Single Payment Credit Card Authority Form can be attached which we will use for a once off payment. Both of these forms are available on our website www.alicespringsairport.com.au

ACCESS CARDS - PRIVACY STATEMENT AND CONDITIONS OF USE

PRIVACY STATEMENT

Collection and disclosure to third parties of the information contained within this application form is required in order to enable the processing of Access Control onto your ASA issued Access Card. The collection and handling of information is in compliance with Division 9 - Aviation Transport Security Act 2004, Part 6 - Aviation Transport Security Regulations 2005, AusCheck Regulations 2007, Alice Springs Airport Transport Security Program and The Privacy Act 1988.

In addition, we may use your personal information for the purposes of assisting ASA with the correct operating of the airport under various legislation, and in the assessment of any possible security incidents or breaches. Information may also be supplied to third parties in conjunction with any federal investigations.

By submitting this application, you consent to ASA collecting, using and disclosing personal information as set out above.

CONDITIONS OF USE AND ISSUE

• Access on card will expire on the same expiry date as the holders’ current ASIC

• Loss of card is to be reported immediately to ASA Airport Management Centre – (08) 8951 1211

• The Access Card remains the property of ASA and must be surrendered on expiry, transfer or termination of present duty, or on request by ASA

• The card may only be used in the course of the cardholder’s approved duties in the Secure Areas and does not constitute an authority to enter or remain in a restricted area for any other purpose

• Access on cards is registered for the use of the person to whom it has been issued only

• Incorrect use of access provisions may result in the immediate withdrawal of access privileges. No refund will be granted

• If you have a separate ASA Access Card with Access Control permissions, then these permissions will expire on the same date that your ASIC expires

• ASA will attempt to reprogram an existing Access Control Card, should the card be deemed damaged or invalid a new Access Control Card will be issued at a cost of $20 in GST

SECURITY AND SAFETY INDUCTION

Before you can have your ASIC or Access Card programmed with access control privileges you must complete the Alice Springs Airport Security Induction. This is a mandatory requirement with the objective of keeping Alice Springs Airport safe and secure.

The induction is based online and consists of multiple choice questions; all questions have been captured from the Airport Security and Safety Guide, available to download here.

Once submitted, please complete your induction (if not already completed) at: ASIC - Aviation Security Identification Card | ASIC Card Renewal. Once your induction has been completed successfully you may collect your access card from the Airport Management Centre (M-F 0800 to 1430 only).

I confirm that i have read and understood the Access Card Privacy Statement and Conditions of Use, and agree to adhere to all requirements as outlined above by Alice Springs Airport *

I understand that failure to comply with the Access Card Condition of Use outlined above will result in my access permissions being revoked at the discretion of Alice Springs Airport *

I certify that the details contained in this application are true and correct and understand I must contact ASA immediately if any of the information changes. *

Applicant Signature *

Draw signature|Type signatureClear

Applicant Signature Date *

PART 2 - TO BE COMPLETED BY EMPLOYER (AUTHORISED SIGNATORY ONLY)

SECTION B - Employer Details

Company Name *

Company Authorised Signature Name *

Preferred Phone Contact Type *

Work Phone Number

Mobile Phone Number

Employer Email Address *

Employer Postal Address *

Street address or PO Box *

City *

State *

Postcode *

SECTION B - Access Requirements

Access Areas Required *

Reason for Access: (You must be specific – justify the applicant’s need to access secure areas by stating actions and duties involved in position) *

EMPLOYER PAYMENT CONFIRMATION

In the event that your employees ASIC cannot be coded, ASA will supply an Access Card at a cost of $20.00 inc GST. Payment for Access Cards must be made at the time of submission; no application will be accepted without payment. If the employee has an existing ASA Access Card we will attempt to reprogram this at no cost

Access Card Cost: $20.00 inc GST

Please select from one of the below in the event that ASIC cannot be coded, and employee does not hold an existing ASA access card:

Access Card Payment *

Company to PayEmployee to Pay

*Please ensure correct cash is presented to the Airport Management Centre upon collection of Access Card by employee

*Payment can be made by presenting to the Airport Management Centre, or by contacting (08) 8951 1211.

*For all Cheque payments, please contact the Airport Management Centre on (08) 8951 1211

*If you are unsure if monthly account payments have been set up for your company, please contact the Airport Management Centre on (08) 8951 1211.

NA Reason *

SECTION C - Employer Certification

I, (Authorised Company Signatory Name) *

(i) confirm that the preceding applicant and employer details are correct and that the applicant requires access to the Security Sensitive Areas at ASA in order to perform their duties for their employment;

(ii) agree to notify ASA of any changes to the above and to recover and return any ASA issued Access Card prior to the applicant leaving employment or upon transfer to a position which no longer has an operational need to retain the Access Card;

(iii) understand that ASA may exercise its right to suspend production of Access Cards for any company who has expired/unrecovered Access Cards that have not been returned to ASA;

I declare that I am listed as an Authorised Company Signatory. *

Employer Signature *

Draw signature|Type signatureClear

Employer Signature Date *

SECURITY CONFIRMATION AND APPROVAL

Is Authorised Company Signatory Valid? (Check SDS) *

YesNo

Declined Reason

Is access requested within operational requirements? *

YesNo

Company Name *

Authorised Company Signatory Email *Separate emails using ", "

Security Induction Completed *

Is DAMP Test Required? *

YesNo

DAMP Completion Date *

Is Carpark Access Required? *

YesNo

Receipt / Account Information

PACOM Updated *

Security Staff Name *

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