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The Following Shall Be Completed By Applicant’s Employer: <br />NE: <br />_____________________________________________________________ <br />AME OF MPLOYER <br />A:C/S/Z: <br />_______________________________________________________ <br />DDRESSITYTATEIP <br /> <br />T: <br />___________________________________ <br />ELEPHONE <br />Supervisor Name:Supervisor Phone # <br /> ____________________________ <br />E-Mail Address: <br /> ________________________________________________________________________ <br />This portion of the application is for the employer to review and approve the issuance of Eugene Airport Access <br />ID and/or key(s) to an employee. The employer authorizes a fingerprint based criminal history record check <br />Only an authorized signer on record with the Airport Security <br />(CHRC) of the employee if necessary. <br />Coordinator (ASC) may sign this application. <br /> If you are not on record as an authorized signer please leave <br />this portion blank and contact the Eugene Airport for further instructions. <br />EIEI <br />MPLOYER TO NITIAL ACH TEM <br /> _As the employer, I accept the ultimate responsibility for costs or fees associated with the applicant’s lost, <br />stolen or non-returned badge as determined by the then current Eugene Airport Fee Schedule. I also <br />understand my company is ultimately responsible for any penalties or fines that may be assessed by <br />Eugene Airport, the Federal Aviation Administration (FAA), Transportation Security Administration (TSA), <br />or other governing agency, as a result of violations incurred by me or my employees while at EUG. <br /> _As the employer, in the event an airport-issued key is lost/stolen and it is determined that recoring is <br />needed to ensure overall airport security, the employer shall be financially responsible for the costs of the <br />recoring. The extent of recoring shall be at the Airport’s discretion. <br /> I have reviewed this application for completeness and verified that the applicant is an employee of the <br />firm stated above. <br /> As the employer I have authorized a fingerprint-based criminal history records checks on this applicant. A <br />10 year employment history and verification is not required. <br />Please check below the purpose for requested access: <br /> Ï <br />C <br />ONSTRUCTION <br />Project:________________________________________________________________ <br /> <br /> Start Date : ____________________________________ <br /> End Date: _____________________________________ <br />Ï <br /> T <br />ENANT <br />Ï <br /> V ___________________________________________________________________ <br />ENDOR <br />Ï <br /> G _____________________________________________________________ <br />OVERNMENTAL <br />Page 5 of 8 <br /> <br />