AIRPORT SECURITY BADGE APPLICATION FORM
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Z:\Badging\Forms\Airport Security Badge Application Form Revised 12/2020 - JG.docx
San Bernardino International Airport
Applicant
Last Name: First Name: M.I.
Terms and Conditions
PLEASE READ CAREFULLY
1. Security Badge remains property of the San Bernardino International Airport. Security Badge shall be immediately surrendered to the Badge
Office upon request thereby, or upon termination of access to the area(s) authorized.
2. Security Badge will automatically deactivate if it is not used within 30 consecutive days.
3. A lost, stolen, or damaged Security Badge must be immediately reported to the Badge Office.
4. Security Badge holder agrees to abide by all applicable Federal, State, and City laws, and Airport Rules and Regulations while on Airport
property.
5. Security Badge is non-transferrable, and is for the sole use of the individual specifically authorized and depicted on the Security Badge.
Loaning, or allowing use of a Security Badge by other individuals is prohibited, and cause for immediate revocation of Security Badge, access
privileges and/or fees through a Notice of Violations (NOV).
6. No person shall knowingly or willfully allow access to unauthorized/unescorted persons in restricted areas by use of the Security Badge.
7. Replacement cost for a lost, stolen, or damaged Security Badge is $40.00 per occurrence.
8. Security Badge holder agrees to display the Security Badge on the outermost garment at all times while on airport property.
9. A copy of a valid driver license (required for AOA drivers), ID or passport must be provided to the Airport prior to receiving a Security Badge.
VIOLATIONS OF AIRPORT SECURITY BADGE TERMS AND CONDITIONS MAY RESULT IN IMMEDIATE
REVOCATION OF SECURITY BADGE, REVOCATION OF ACCESS PRIVILEGES, AND/OR FINES
DISQUALIFYING CONDITIONS
Criminal History Disclosure: Within the last 10 years, have you been convicted or found not guilty by reason of insanity of any of the
following offenses? (Check either YES or NO per line, as applicable)
Note: Any conviction or non-conviction by reason of insanity for one or more of the following is grounds for denial of an
SBD Airport Security Badge.
Forgery of certificates, false marking of aircraft, and other aircraft registration
violations (49 U.S.C. 46306)
Aircraft piracy (49 U.S.C. 46502)
Interference with air navigation (49 U.S.C. 46308)
Improper transportation of a hazardous material (49 U.S.C. 46312)
Assault with intent to murder
Violence at international airports (49 U.S.C. 37)
Interference with flight crew members or flight attendants (49 U.S.C. 46504)
Commission of certain crimes aboard an aircraft in flight (49 U.S.C. 46506)
Kidnapping or hostage taking
Carrying a weapon or explosive aboard an aircraft (49 U.S.C. 46505)
Conveying false information and threats (49 U.S.C. 46507)
Rape or aggravated sexual abuse
Unlawful possession, use, sale or distribution or manufacture of an explosive or
weapon
Violations involving transporting controlled substances (49 U.S.C 46315)
Unlawful entry into an aircraft or airport area that serves air carriers or foreign air
carriers contrary to established security requirements (49 U.S.C. 46314)
Distribution of, or intent to distribute a controlled substance
Destruction of an aircraft or aircraft facility (49 U.S.C. 32)
Armed or felony unarmed robbery
Aircraft piracy outside the special aircraft jurisdiction of the United States (49
U.S.C. 46502(b))
Felony involving dishonesty, fraud, or misrepresentation
Felony involving possession or distribution of stolen property
Felony involving a threat
Felony involving willful destruction of property
Felony involving aggravated assault
Felony involving importation or manufacture of a controlled substance
Felony involving burglary
Felony involving illegal possession of a controlled substance punishable by a
maximum term of imprisonment of more than 1 year.
Conspiracy or attempt to commit any of the aforementioned
criminal acts
