ARE YOU QUALIFIED?

1

What Is your name?

First Name

Last Name

2

What is your email?

example@example.com

3

What Is your phone number?

Please enter a valid phone number.

4

How Tall are you?

5

What Is your current weight?

6

Where Do you/did you attend high school?

7

How Old are you?

8

Where Were you born?

9

Have you ever used any illegal drugs?

YESNO

10

Have you ever had any involvement with the police?

YESNO

11

Have You ever taken the ASVAB?

YESNO

12

Do You have any tattoos on your hands, neck, or face?

YESNO

13

Do You have any piercings, gauges, or brands?

YESNO

14

Type a question

YESNO

15

Do You have/have you had any Implants/Pins/Plates/Screws

YESNO

16

Have You ever had any prescribed medications?To include ADD/ADHD/Anxiety/Depression

YESNO

17

Have You ever seen a psychiatrist or counselor for mental health reasons?

YESNO

18

Have you ever had any seizures/concussions/head injuries?

YESNO

19

Have You ever broken/fractured a bone or dislocated a joint?

YESNO

20

Have You ever had any kind of operation or surgery?Wisdom teeth and tonsils are included

YESNO

21

Have You ever had asthma or used an inhaler?

YESNO

22

Do You have any kind of allergies?

YESNO

23

Do You wear glasses/contacts or have vision issues?

YESNO