102 IW / Mass Air Guard Applicant Pre-Screening Questionnaire

1
Full Name* This field is required.First, Middle, Last
First Name
Middle Name
Last Name
2
Home Address* This field is required.Where do you live? Not your mailing address (i.e. P.O. box, etc...).
Street Address
Street Address Line 2 (i.e. Apartment, Suite Number, etc...)
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Phone Number* This field is required.Please provide the phone number that you use the most.
4
Height / Weight* This field is required.How tall are you? How much do you currently weigh?
Height (i.e. 5'9", 5'10", etc...)
Weight
5
Eye ColorWhat color are your eyes?
6
Hair ColorWhat color is your hair?
7
E-mail* This field is required.Please provide the e-mail that you use the most.
example@example.com
8
Date of Birth* This field is required.MM/DD/YYYY
9
ReligionWhat is your religious preference? If no religious preference, just put N/A.
10
Birthplace* This field is required.Where were you born?
11
U.S. CitizenshipPlease select what best applies to you from the below drop-down menu:
U.S. Citizen
Dual U.S. Citizen
Permanent Green Card holder
Non-U.S. Citizen
12
U.S. Citizenship (cont'd)* This field is required.What country are you from?
13
Selective ServiceAre you registered with the U.S. Selective Service System?
YESNO
14
Selective Service (cont'd)What is your Selective Service number? If you don't know, go to https://www.sss.gov/verify/ and follow the prompts.
15
Driver's LicenseDo you have a current/active Driver's License?
YESNO
16
Driver's License (cont'd)What state issued your Driver's License? And what is the License Number?
(I.e. Massachusetts; S2XXXXXXX, etc...)
17
Marital Status* This field is required.
Single
Married to a Civilian
Married to a Military Member
Divorced / Separated
18
Military Status* This field is required.
Non-Prior Service (Have Never Served)
Prior Service (Have Served & Seperated)
Actively Serving in the U.S. Air Force
Actively Serving in a Different Branch of Service
19
Military Status (cont'd)* This field is required.What were your dates of service? What is your Re-Entry / Re-Enlistment (RE) Code?
20
Military Status (cont'd)* This field is required.What is your ETS?
21
Highest Education Level* This field is required.High School, GED, Associate Degree, Bachelor Degree, etc...
22
Youth Paramilitary ParticipationHave you ever participated with a youth paramilitary organization (i.e. Junior Reserve Officer Training Corps (JROTC), Boy/Girl Scouts of America, Civil Air Patrol (CAP), etc...)?
YESNO
23
Youth Paramilitary Participation (cont'd)Please enter the youth paramilitary organization you participated with.
24
Criminal History* This field is required.Have you ever been charged, arrested, cited, held or questioned by any law enforcement agency to include minor traffic and juvenile violations regardless of the disposition?
YESNO
25
Criminal History (cont'd)* This field is required.What was the nature of the offense? When did it occur? What was the outcome?
26
Drug Use* This field is required.There is no pre-limit amount of marijuana use that will disqualify you before processing, so please answer truthfully. Have you ever used, sold, possessed, and/or transported any illegal drugs to include marijuana?
YESNO
27
Drug Use (cont'd)* This field is required.What drug did you use? When was the last time used? How many times?
28
Drug / Rehabilitation* This field is required.Have you ever completed a drug and/or rehabilitation program?
YESNO
29
Drug / Rehabilitation (cont'd)* This field is required.What was the nature of the rehabilitation program? When did you attend it? What was the outcome?
30
Prescription Medications* This field is required.Have you ever or are you currently taking any prescription medications?
YESNO
31
Prescription Medications (cont'd)* This field is required.Please list specific medication(s) and dates taken.
Huge
Large
Normal
Small
Ok
Ok
32
Mental Health* This field is required.Are you now or have you ever been sign by a therapist, counselor, and/or psychologist?
YESNO
33
Mental Health (cont'd)* This field is required.How long did you visit with the mental health professional? What was the outcome?
34
Body Piercing(s) / Augmentation* This field is required.Do you have any body piercings and/or body augmentations?
YESNO
35
Body Piercing(s) / Augmentation (cont'd)* This field is required.What piercing(s) / augmentation(s) do you have? Note: All body piercing(s) must be removed while at the Military Entrance Processing Station (MEPS), Basic Military Training (BMT), Technical Training School, and while in uniform.
36
Tattoos* This field is required.Do you have any tattoos?
YESNO
37
Tattoos (cont'd)* This field is required.Where on your body are the tattoos located? What are they of? (i.e. Symbolism, etc...)
38
Medical History* This field is required.Have you ever been diagnosed with and/or had any medical treatment for any of the following: eczema, broken bones, artificial parts, asthma, surgeries, and/or attention deficit hyperactivity disorder (ADHD)? Have you ever been hospitalized?
YESNO
39
Medical History (cont'd)* This field is required.Please list specifics medical diagnoses, treatments, and/or hospitalizations.
40
Conscientious Objection* This field is required.Are you a conscientious objector? A conscientious objector is an individual with affirm, fixed, and sincere objection to the participation in war or to the performance of military service due to religious trainings or beliefs.
YESNO
41
How did you hear about us?* This field is required.Please select one of the options from the below drop-down menu:
Social Media
Referred by a Friend/Family Member
Business Card
Recruiting Event (I.e. Career Fair)
Other
42
Other* This field is required.Please briefly explain how you heard about us.
Should be Empty: