Basic Screening Questions
In order to let you know whether or not you are completely qualified for a potential rewarding career in the military, please complete the following questions to the best of your abilities.
What is your full legal name?
*
First Name
Middle Name
Last Name
Suffix
What is a good contact number?
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your date of birth?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What high school do/did you attend? Include your graduation class year.
*
Do you have any open/closed misdemeanors or felonies? (Any speeding tickets as well?)
*
No
Yes (specify below)
If yes above, please specify. If no, type "N/A".
Are you a legal US Citizen?
*
No
Yes
Green Cardholder
What is your height and weight? (For example: 5'7 and 120lbs)
*
Have you ever had any implants, screws, pins or bolts inputted surgically into your body?
*
Please Select
YES (not any longer)
YES (currently)
NO
If yes above, please specify. If no, type "N/A".
Have you ever seen a counselor, psychologist, psychiatrist, or physiologist for any OFFICIAL DIAGNOSISES for things like ADD, ADHD, depression, PTSD, anxiety, suicidal ideations, IEP/504 plan, etc.?
*
Please Select
YES
NO
If yes above, please specify. If no, type "N/A".
Have you ever been through any major or minor operations or surgeries?
*
Please Select
YES
NO
If yes above, please specify. If no, type "N/A".
Are you currently on any prescribed medication? Not including over the counter meds or birth control.
*
Please Select
YES
NO
If yes above, please specify. If no, type "N/A".
Have you ever had any broken bones, fractures, amputations, or dislocations of any limbs?
*
Please Select
YES
NO
If yes above, please specify. If no, type "N/A".
Have you ever had asthma or had to use an inhaler or ventilator for any lung issues?
*
Please Select
YES
NO
If yes above, please specify. If no, type "N/A".
Do you have any tattoos on the face, head, neck, or below the wrist?
*
Please Select
YES
NO
Is anyone dependent upon you for financial care? Wife, Husband, or kids.
*
Please Select
YES
NO
Are you currently on any drugs like MJ, K2, Spice, Mushrooms, Cocaine, LSD, etc.?
*
Please Select
YES
NO
This is only to determine if you would need time to pass a urinalysis in the future.
Anything at all that you believe could prevent you from enlisting into the U.S. Military in the future?
Submit
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