Eligibility Screening Form
Last Name
*
First Name
*
Middle Initial
Sex
*
Please Select
Male
Female
Race or Ethnicity
Are you a US Citizen?
*
Please Select
Yes
No
Phone Number
*
-
Area Code
Phone Number
E-mail
*
College/University
*
Academic Major
Estimated Graduation Date?
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
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12
13
14
15
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19
20
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25
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27
28
29
30
31
Day
Please select a year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
Year
Current GPA
*
Have you taken the SAT, ACT or ASVAB?
*
Please Select
Yes, SAT
Yes, ACT
Yes, ASVAB
No
What did you score on the Math and Reading Sections of the SAT?
*
What is your COMPOSITE ACT score?
*
What did you score on the ASVAB?
*
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
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1969
1968
1967
1966
1965
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1963
1962
1961
1960
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1958
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1956
1955
1954
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1952
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1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Place of Birth
How tall are you in inches?
*
How much do you weigh?
*
Vision Problems?
*
Please Select
Yes
No
Please Explain:
*
Vision Correctable to 20/20?
*
Please Select
Yes
No
Do you have asthma or allergies?
*
Please Select
Yes
No
Please provide details:
*
Have you ever been on medication?
*
Please Select
Yes
No
Please list all medications:
*
Medical Conditions?
*
Please Select
Yes
No
Medical Condition Details:
*
Any broken bones or surgeries?
*
Please Select
Yes
No
Broken Bones/Surgery Details:
*
Have you ever been hospitalized?
*
Please Select
Yes
No
Please Explain:
*
Have you ever seen a medical specialist, counselor, or psychologist?
*
Please Select
Yes
No
Please Explain
*
Do you have any tattoos ?
*
Please Select
Yes
No
How many tattoos do you have?
*
Please Select
1
2
3
4
5 or More
Please describe tattoo and location:
*
Do you have any piercings?
*
Please Select
Yes
No
How many piercings do you have?
*
Please Select
1
2
3
4
5 or More
Please list piercing location and gauge:
*
Traffic Tickets?
*
Please Select
Yes
No
Traffic Tickets Details
*
Have you ever been arrested?
*
Please Select
Yes
No
Arrest Details:
*
Have you EVER used drugs?
*
Please Select
Yes
No
Details about drug use:
*
Marital Status?
*
Please Select
Single
Married
Separated
Divorced
Children?
*
Please Select
0
1
2
3
4 or More
Prior Military Service?
*
Please Select
Yes
No
What Branch of Service?
*
Please Select
Army-Active Duty
Army-Reserves
Army-National Guard
Air Force-Active Duty
Air Force-Reserves
Air National Guard
Navy-Active Duty
Navy-Reserves
Marines-Active Duty
Marines-Reserve
Coast Guard
AROTC, AFROTC, or NROTC
Service Academy
Please provide details:
Do you workout?
*
Please Select
Yes
No
How many times per week do you work out? What kind of workouts do you do?
*
How did you hear about us?
*
Please Select
Mail, Email, or Phone Call
Facebook
Other Internet Website
Local Recruiter
TV Commercial
Other
What website?
*
Submit
Should be Empty: