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Employee Authorization Form

  1. MOT New LOGO
  2. Employee Authorization Form
    Completed by Authorized Signatory Only
  3. Badge Applicant Information
  4. Badge Type
  5. I-9 Document Verification
    Please see "Badge Identification Requirements" Document
  6. Was Applicant born outside the U.S.?*
  7. Applicant was born outside the U.S., has a VALID passport, Certificate of Birth Abroad or Certificate of Naturalization and Social Security Card and can provide these items.*
  8. Is Applicant a United States Citizen? *
  9. Applicant is NOT a U.S. Citizen. *
    Applicant will present Foreign Passport and Form I-94 or Permanent Resident Card.
  10. I hereby certify that the above named applicant will abide by TSA and Minot International Airport security regulations. I further certify that the organization I represent assumes all responsibility for all fines, or other penalties imposed by the TSA upon the Minot International Airport for any violation(s) by this applicant. Furthermore, if movement area access is requested, I certify that the applicant has received the appropriate training as it relates to ground vehicle operations regulations and in relation to the level of job responsibilities that they will perform. I certify that I will collect the unescorted access identification media from the employee immediately upon termination of his/her unescorted access and return the badge to Airport Administration within five (5) days.
  11. By checking the "I agree" box below, you agree and acknowledge that:*
    1) Your application will not be signed in the sense of a traditional paper document,
    2) By signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and
    3) You may still be required to provide a traditional signature at a later date.
  12. Airport Badging Office
    305 Airport Road
    Suite 216
    Minot, ND 58703
    Phone: 701-857-4724
  13. Leave This Blank:

  14. This field is not part of the form submission.