LAST NAME : FIRST NAME :

MIDDLE : SUFFIX : JR. SR. I II III IV V

HOME NUMBER : WORK NUMBER :

E-MAIL :

STREET :

CITY/COUNTY : STATE : ZIP :

AGE : 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

PRIOR SERVICE : None Air Force Army Coast Guard Marine Corps Navy Air National Guard Army National Guard RANK : N/A E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 WO-1 WO-2 WO-3 WO-4 WO-5 O-1 O-2 O-3 O-4 O-5 O-6 O-7

PHYSICAL CONDITION: Average Above-Average Below-Average

LAW VIOLATIONS (Choose Highest) : None Minor Traffic Major Traffic DUI Drug Violations Felony

EDUCATION : Non-High-School Graduate GED High School Graduate 15+ College Credits 30+ College Credits 60+ College Credits 90+ College Credits 120+ College Credits Associate's Degree Bachelor's Degree Master's Degree Doctorate

MARITAL STATUS : Single Married Separated Divorced

DEPENDENTS : 0 1 2 3 4 5 6 6+

BRANCH OF INTEREST : Undecided Admin Air Defense Artillery Aviation Cook Engineer Finance Infantry Intelligence Maintenance Medic Military Police Signal Supply Officer Warrent-Officer

ADDITIONAL INFO/REQUESTS :