ABOUT ME
Thank you for your interest in the United States Army. I am Sergeant First Class Darrin Burnett-Smith. I serve as an Army Recruiter in Fairfield-Suisun, CA. 🌴🌤 My job is to find highly motivated & qualified individuals to join the world's greatest organization. As your Recruiter, you are my #1 priority, and I will ensure all your questions & concerns are answered. 💯 Below is a pre-qualification form to schedule an appointment with me. Please be detailed and fill the form out to the best of your knowledge. 💭 I will be in contact with you soon, thank you! 🇺🇸
U.S. Army Pre-Qualification Form
Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
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Month
Please select a day
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Day
Please select a year
2026
2025
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1922
1921
1920
Year
Gender
*
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
-
Area Code
Phone Number
Height
*
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
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79
80
select your height in inches
Weight
*
type your weight in pounds
Highest Education Level?
*
H.S. Student
H.S. Graduate
GED
Some College
College Graduate
Citizenship Status?
*
U.S. Citizen at Birth
Naturalized
Derived U.S. Citizen
Permanent Resident
Other
Marital Status?
*
Single
Married
Divorced
Other
Do you have a valid State ID or Driver's License?
*
Yes
No
Do you have any Children or Legal Dependents?
*
Yes
No
Have you ever taken the Armed Services Vocational Aptitude Battery (ASVAB) test?
*
Yes
No
Have you served in any other branch of the Armed Forces?
*
Yes
No
Do you have any Tattoos?
*
Yes
No
Have you EVER used, possessed, sold, or transported any illegal drugs to include marijuana?
*
Yes
No
Have you ever been charged, arrested, cited, held, or questioned by a law enforcement agency to include minor traffic, juvenile offenses, regardless of the disposition/outcome (charges were dropped, dismissed, found not guilty)?
*
Yes
No
Please select any of the following items that pertain to you? (Select all that apply)
*
Any arrests or had any encounters with law enforcement to include tickets?
Used any illegal drugs for abused prescription drugs?
Any metal implants? (i.e. Pins plates or screws etc.)
Wear contacts or glasses?
Had or recommended to have any operations or surgeries?
Medications prescribed by a Doctor?
Broken/ fractured any bones?
Any breathing problems? (i.e. Asthma)
Have tattoos, branding or piercings?
Any vision problems? (i.e. Color blind, stigmatisms, lazy eye, etc.)
Received any type of counseling/psychiatric care?
Prescribed medications for ADD, ADHD, Depression, or Anxiety?
Are you allergic to anything? (i.e. Foods, Bee Stings, Medications etc.)
None
What career fields interest you?
*
Select the employment benefits that interest you the most? (select all that apply)
*
Free Tuition
30 Days Paid Vacation
Professional Development
Job Security
Early Retirement
Annual Pay Raises
Pride of Belonging
Self-Discipline
Free Medical/Dental
Leadership Training and Experience
Travel and Adventure
Financial Security
Additional Comments | How did you hear about the Army and local recruiter?
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