U.S Army and U.S Army Reserves

U.S. Army

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Gender*

MaleFemalePrefer not to sayOther
Full Name*

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

Area CodePhone Number
Date of Birth*

DayMonthYear
Citizenship Status:*

US CitizenPermanent Resident (I-551Card)Other
Martial Status:*

SingleMarriedDivorced
Do you have dependents?*

YesNo
Education: Are you a High School graduate?*

YesCurrently a High School SeniorGEDNo 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.)*

YesNo
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