Military Questionnaire

United States Marine Corps

Completion of the questionnaire DOES NOT abligate you to enlist into the Miliary.
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number*
Format: (000) 000-0000.
High School *
Select your level of education.

9th10th11thHigh School graduateAssociate'sBachelor's
Height*
select your height in inches
Weight*
type you weight in pounds
Where were you born? *
Country
City, State*
Citizenship Status:

U.S. CitizenPermanent ResidentOther
Do any of the following items 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)Had 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.)Have you ever been diagnosed with COVID 19?
What career fields interest you?
Select the employment benefits that interest you (select all that apply)

Free Tuition30 Days Paid VacationProfessional DevelopmentJob SecurityEarly RetirementAnnual Pay RaisesPride of BelongingSelf-DisciplineFree Medical/DentalLeadership Training and ExperienceTravel and AdventureFinancial SecuritySelf-DirectionSelf-Reliance
Would you consider receiving more information regarding the Marines Corps?

YesNoDo not contact list
What questions do you have regarding the Marines Corps or the Armed Forces?
Appointment
Should be Empty:

United States Marine Corps