Do struggle
When listing all references, DO NOT exercise any family or relatives and DO NOT invoice anyone twice!
At any section in this con~ation, if more entries need to subsist made, continue on the back of that single page.
Also information given in this packet is protected by the Privacy Act Statement of 1974
ENLISTMENT SECURITY QUESTIONNAIRE
PERSON
SSN_________________________LAST NAME___________________________FIRST NAME_______________________________
MIDDLE NAME__________________________DOB (YYMMDD)__________________ CITY OF BIRTH__________________________
COUNTY OF BIRTH______________________STATE OF BIRTH____________ COUNTRY OF BIRTH__________________________
GENDER____________________ HEIGHT________WEIGHT___________EYE COLOR______________ HAIR COLOR____________
REIGISTERD TO VOTE? YES NO PRIOR SERVICE YES NO
RACE_____________________AGGREGATE RATE__________________________ETHNIC CATEGORY_________________________
RELIGION ___________________________________________________________________
DRIVERS LICENSE STATE_________ EXPIRATION DATE (YYMMDD)______________ LICENSE #___________________________
MARITAL STATUS______________________TOTAL DEPENDENTS______________ MINOR DEPENDENTS___________________
CURRENT ADDRESS: STREET_____________________________________________________ CITY__________________________
COUNTY________________________ STATE____________________ZIP_____________________ COUNTRY_____________________
DATES AT CURRENT ADDRESS: FROM (YYMMDD)_______________________ TO (YYMMDD)______________________
CURRENT TELEPHONE #: CELL: __________________________________ HOME:__________________________________________
PHYSICAL SCREENING CRITERIA
PERSONAL SCREENING CRITERIA
ALIASES
ALIAS NAME TYPE________________________ LAST NAME_________________________FIRST NAME________________________...
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