U.S Army and U.S Army Reserves

U.S. Army

Interested in more info🙏
Gender *

Male Female Prefer not to say
Full Name *

First Name Last Name
Do you live in Los Angeles County, or Orange County? *
Phone Number *

Area Code Phone Number
Date of Birth *

Day Month Year
Citizenship Status: *

US Citizen Permanent Resident (I-551Card)
Martial Status: *

Single Married Divorced
Do you have dependents? *

Yes No
Education: Are you a High School graduate? *

Yes Currently a High School Senior GED No High School Diploma or GED
Physical: How tall are you? *
How much do you weigh? *
Do you have any piercings or tattoos? If so, describe where. *
Have you had any surgeries? *
Do you have any medical conditions that might disqualify you from military service? If so, please give a brief explanation. *
Law: Do you have any minor law violations? (speeding tickets, trolley tickets, jay walking, etc.) *
Do you have any major law violations? (Misdemeanors, DUI’s, Felonies, etc.) *

Yes No
Have you ever taken the Armed Services Vocational Aptitude Battery Exam (ASVAB)? If so, when and what military branch? *
Whom do you know of that might benefit from talking to an Army Recruiter? A referral with a Name and Phone Number would be greatly appreciated! Thanks for your time! *
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U.S. Army