Active Duty Air/Space Force Questionnaire

Active Duty Air/Space Force Questionnaire
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 8013, Secretary of the Air Force; 44 U.S.C. 3101; and Executive Order 9397 (SSN), as amended.
PURPOSE: To collect and maintain personal information to support Air Force personnel and administrative programs.
ROUTINE USES: The information may be disclosed to other federal agencies or organizations as necessary in the performance of their official duties, in accordance with the Privacy Act of 1974 and the Blanket Routine Uses as published in the Federal Register.
DISCLOSURE: Voluntary. However, failure to provide the requested information may result in administrative delays or the inability to complete the requested action or process.
I understand the above Privacy Act Statement and wish to proceed to start the process for Enlisted Active Duty Air/Space Force
I understand this is to start the process for Active Duty Air/Space Force
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have a driver’s license?
Email
example@example.com
How did you find my info?
Gender
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Citizenship
If applicable, when does Greencard Expire

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If applicable, what is your country of birth on the Greencard.
Height (Inches)
Weight (Pounds)
Marital Status
Number of Children
Level of Education (US Equivelancy)
If you’re a High School Junior/Senior, what school do you currently attend?
Do you have tattoos? Describe location and description of them.
Do you have piercings? Are they removable? Are any of them gauges?
Please disclose any history of law violations to include open, closed, expunged, sealed, dismissed; Were you ever charged, arrested, cited, held, detained, questioned by law enforcement agencies? (FULL DISCLOSURE IS NECESSARY. BACKGROUND CHECK WILL BE CONDUCTED).
Any history of drug usage to include Marijuana?
Explain what drugs and total times.
Has a doctor ever said you were allergic to something?
If allergic, what happens when you encounter the thing? (Itchy, swelling, anaphylactic, rash, etc.)
Have you ever had any medical history of the following in your life?
Please explain any medical history that was identified.
Are you currently taking any medication?
Please explain what you’re taking and why.
Do you currently have braces, Invisalign, or aligners?
When does your braces/aligners come off?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you have any history of late payments, accounts in collection, filed bankruptcy, vehicle repossession, or other derogatory credit issues?
Please explain financial issues.
Why do you want to join the Air Force?
Name and Number of someone who might be interested.
Careers I might be interested in
Are you Prior Service? (Served in the US Armed Forces before)
Have you taken the official ASVAB before? If yes, when did you take it and what did you score.
Have you completed your MEPS Physical? If yes, when did you complete it and what was the outcome? (Qualified, Disqualified, etc.)
Have you spoken to another Recruiter before? How far along did you work with them?
I’m ready to join the Air Force

1

2

3

4

5

1 is Not Ready, 5 is Ready
If qualified, when would you like to start your journey?
Should be Empty: