Recruitment Qs

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

What high school did/do you attend?

5

How tall are you and how much do you weigh?

6

Age?

7

Are you a Citizen/Resident

YESNO

8

Have you ever used illegal drugs?

YESNO

9

Since you answered YES. What drug? How many times? Last used? Drug usage continued.

10

Have you ever had any involvement with the police?

YESNO

11

Since you answered YES. What was it? When? Resolution?Police Involvement continued.

12

Have you ever taken the ASVAB test?

YESNO

13

Since you answered YES. When? Score?ASVAB continued.

14

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

YESNO

15

Do you have any piercings or brandings?

YESNO

16

Since you answered YES. What? Where?Piercings/Brandings continued

17

Have you ever had any medical operations/surgeries? (Implants/Pins/Plates/Screws)

YESNO

18

Since you answered YES, please provide a brief summary.Medical Operations/Surgeries continued.

19

Have you ever taken any Prescribed Medications?

YESNO

20

Since you answered YES, please provide a brief summary.Prescribed Medications continued.

21

Have you ever seen a Counselor for Depression/Anxiety

YESNO

22

Since you answered YES, please provide a brief summary.Counseling continued

23

Have you ever had any Seizures/Concussions/Head Injuries

YESNO

24

Since you answered YES, please provide a brief summary.Seizures/Concussions/Head Injuries continued.

25

Have you ever Broken/Fractured Bones or have Joint Issues?

YESNO

26

Since you answered YES, please provide a brief summary.Broken/Fractured Bones and Joint Issues continued.

27

Do you have any Allergies?

YESNO

28

Since you answered YES, please provide a brief summary.Allergies continued.

29

Have you ever had Asthma or use an Inhaler?

YESNO

30

Since you answered YES, please provide a brief summary.Asthma/Inhaler continued.

31

Do you have Contacts/Glasses/Vision Issues?

YESNO

32

Since you answered YES, please provide a brief summary.Contacts/Glasses/Vision Issues continued.