Air National Guard Personal Interview/ Pre-Qualification Worksheet

Today’s Date: 		How did you hear about us?	

Name (L, F, Full Middle): 	SSN:		
Sex: (M/F) Preferred Gender: (M/F)	DOB:	 Age: 	
Home Phone: 		Cell Phone:	
Street Address	City	State	Zip 		 Email: 		City, State of Birth: 			
Marital Status: 		 Spouse Status:Civilian/Military		# of Minor Dependents:	 Height: 	Weight: 		Hair Color: 	 Eye Color: 	
Race (Native American/Alaskan/Asian/Black/Pacific Islander /White): 		Hispanic/Latino	Y/N
US Citizen: Y/N Religious Preference: 							  Drivers License/ID Number: 				 Exp. Date: 		 State of Issue: 	 High School: 			 City/State: 			 Grad Date: 	 College/University: 			 City/State: 			 Grad Date: 	 Sem. /Qtr Credits hours:		Major:			
(CIRCLE ONE)
Have you taken the ASVAB?: Y/N
ROTC:	Y/N	Civil Air Patrol: Y/N	Girl/Boy Scout: Y/N	Eagle Scout: Y/N	Peace Corp:	Y/N
Prior Military Service: Y/N (If your answer is PRIOR SERVICE, please complete information below.) Please circle one: USAF, USN, USMC, Army, USCG-AD, Reserve, or Guard	Complete at least 6 weeks of BMT:	Y/N	Are you requesting either a Palace Chase or Palace Front (Active AF only): Y/N (If yes, please circle which option.)
Branch	Grade	Dates of Service	RE	SPD	Type of Discharge	AFSC/MOS/NEC	Job Title	

Law Violations: Y/N (If your answer is YES, please complete below.)
Charge	Date	Date Paid	Location	Amt of Fine	Paid	
					Y/N	
					Y/N	
					Y/N	

Illegal Drugs:	Y/N Type: 	 #of Times: 	 Date of last use: 	 Marijuana usage: Y/N
Any Allergies: Y/N Type: 	
Tattoos: Y/N If yes, location/s, Content: 	Brands/Ear Gauges: Y/N
PRK/LASIK: Y/N Color Blind: Y/N Asthma: Y/N Have you taken a physical for any branch of service? Y/N Surgeries/Hospitalizations: 	 Medical Conditions: 	 Current Mediations: 	 Credit Problems: 	

ANG Applicants
APPLICATION CHECKLIST AND INSTRUCTIONS
In order to facilitate your application, I’ll need you to gather and send the following items to me. Once I have reviewed your package I will give you further instructions to continue the process.
Current Military Members Documents

	AF Form 1288 or DD 368– (Application for Ready Reserve Assignment). Please type or print neatly in ink.
Remember to sign and date the bottom of the first page. Don’t forget to initial blocks 21-26 and circle either “have or have not” in blocks 22 and 24. I will sign the necessary endorsements and complete page 2 for you.

	Records Review RIP or other services equivalent. From V-MPF, select self-service actions, then personal data, then record review/update, then view/print all pages. You may also order a RIP from your MPF. Other Branches please pull a full services record review (RPAS)

	(Reserves only) Retirement Point Summery. From V-MPF, select self-service actions, then personal data, ANG/USAFR Point Credit Summary Inquiry (PCARS)

	AF Only Physical Fitness test results. You must have passed with a score of 75% or better to apply, your results must be less than one year old upon your enlistment in the ANG.

	Palace Chase Palace Front Applicants ONLY Complete the ISR questionnaire (self-explanatory)

Medical Clearance Checklist: (ALL FORMS MUST BE WITHIN 6 MONTHS)
AF 422 or AF 469
PT Test Dental 603A PHAQ
IMR
DD 2766

Other Forms needed for Enlistment

	Marriage Certificate

	YOUR Birth Certificate and Spouses/ Children Birth Certificate

	Your SSN Card

	Divorce Decree/ Child Support paperwork

	Any Discharge Paperwork from Any Branch of Services (DD 214, NGB 22, Res Separation Order)

	Driver Licenses

	High School Diploma, College Transcripts (for any college)