Instruction for completing this form

Please return this form to DLIS-VSM (ERLS Access), 74 Washington Ave N STE 7, Battle Creek MI 49017-3084. FAX: Commercial (269) 961-5925 or DSN 661-5925. These instructions are for completing the Environmental Reporting Logistics System (ERLS) registration form. Contractor completes Blocks 1, 3 and 4. U. S. Government sponsor completes Block 2. Command Security or Personnel completes Block 5.

PLEASE TYPE OR PRINT CLEARLY.

This is a Department of Defense (DoD) computer system. DOD computer systems are provided for the processing of official U.S. Government information only. All data contained on DoD computer systems is owned by the Department of Defense, may be monitored, intercepted, recorded, read, copied, or captured in any manner and disclosed in any manner, by authorized personnel. There is no right to privacy in this system. System personnel may give to law enforcement officials any potential evidence of crime found on DoD computer systems. Use of this system by any user, authorized or unauthorized, constitutes consent to this monitoring, interception, recording, reading, copying, or capturing and disclosure.

Block 1. Agency Information - Please provide information on the branch of the Government where you are presently working.

U.S. Government Branch of Service or Agency:____________________
(Such as Army, Navy, Air Force, DLA, etc.)

Major Command:_____________________________________________
(Such as Army Materiel Command, Defense Reutilization and Marketing Service, etc.)

Activity Name:_____________________________________________
(Such as DRMO Lewis, DSCR, DDNV, etc.)

Installation Name:___________________________________________
(For example, Fort Lewis, Wright-Patterson AFB, DSCP, etc.)

Block 2. Government Contract Office Representative (COR)
(By signing this block, you agree that the contractor named in Block 4 needs access to Environmental Reporting Logistics System (ERLS) in order to perform their contractual obligations at your agency.)

COR Signature:__________________________________________

COR Name (Print):_______________________________________

Office Symbol/Code/Mail Stop:____________________________

Organization:___________________________________________

Street/PO Box:__________________________________________

City/State/ZIP Code:_______________________________ ______

City/Country (If APO or FPO address):_______________________

Commercial Phone:__________________DSN:________________

Email Address:__________________________________________

FAX:__________________________________________________

Contractor Level of Access to be Assigned:
(This is for the employee named in Block 4 of this form).

Levels of Access:

Access Range: Check one box only.

   ____ Activity information where employee is located.

   ____ Activity and Installation information where employee is located (they must have installation reporting requirements for this access)

   ____ Installation information where employee is located plus other installations including off site or generator sites.

   ____ Region information (read only)

Type of Access: (refer to instruction sheet for category explanation)

Select One:

_____ Activity Group
_____ Installation Group
_____ DRMO Level 1 user
_____ DRMO Level 2 user
_____ Chemical Manager
_____ ICP Group
_____ HQ DLA

Block 3. Company Name and Mailing Address, Contractor Point of Contact Information:

POC Name:______________________________________________

Company Name:__________________________________________

Street Address/PO Box:____________________________________

City/State/ZIP Code:_______________________________________

City/Country (If APO or FPO Address):________________________

Commercial Phone:_________________________DSN:___________

FAX:____________________________________________________

Email:____________________________________________________

Contract Number:__________________________________________

Length of Contract:

End Date__________________________________________________

Block 4. ERLS User Information.

As a user of ERLS, I acknowledge my responsibility to conform to the following requirements and conditions as established by DLA:

I understand the need to protect my password. I will NOT share my password and/or account.

I understand that I am responsible for all actions taken under my account. I will NOT attempt to ‘hack" the network or any connected information system or network, or attempt to gain access to data for which I am not specifically authorized.

I acknowledge my responsibility to comply with all copyright laws both federal and state (where applicable).

I understand my use of DLA information systems is subject to monitoring to ensure proper functioning, to protect against improper or unauthorized use or access, and to verify the presence or performance of applicable security features or procedures. By using the information system I consent to such monitoring.

I acknowledge my responsibility to conform to the requirements stated above when using DLA information systems or networks. I also acknowledge that failure to comply with these requirements and conditions may constitute a security violation resulting in denial of access to DLA information systems, networks or facilities and that such violations will be reported to appropriate authorities for further action as deemed appropriate.

I understand the need to protect my password. I will NOT share my password/and /or user ID. If I no longer need access to ERLS, it is my responsibility to notify DLIS.

USER SIGNATURE___________________________DATE:__________

Printed Name:__________________________________________________

Social Security Number (last six digits only):_________________________

DLA Standard LOGON:__________________________________________

Email:________________________________________________________

Commercial Phone:________________________DSN:__________________

DODAAC:________________________RIC+1:_________________________

(DRMOs only)

Personal Identification Information – (This may be your favorite color, sports team, hobby or phrase.)

(1)_________________________________________________________

Block 5. Security Verification

Your Command Security Office, or your personnel office can provide this information. If you cannot locate your security or personnel office and have official U.S. Government documentation of your background investigation, you can attach it to this registration form in lieu of filling out this block. Please be aware that the minimum background check that is acceptable for ERLS is a National Agency Check with Inquiries (NACI) with a rating of ADP II.

Note to the Security Officer: Access to this system requires the user to have a National Agency Check with Inquiries (NACI) or equivalent type of Investigation and an ADP II rating . If this level of investigation has not been completed for this person, contact the Defense Security Service at http://www.dss.mil for assistance.

Type of Investigation for requester named in Block 4:

Employee Name:_____________________________________________

Type of Investigation:______________Completed on:______________

ADP Level (circle one) ADPI   ADPII   ADPIII

By (Agency):________________________________________________

Signature of Security Representative:___________________________

Typed Name of Security Representative:_________________________

Title:__________________________________ Date:________________

Commercial Phone:_______________________ DSN:______________