Thank you for your interest into the United States Army. Please fill out the below information and we will get in touch with you about setting up an appointment. The following is private information and is covered by the privacy act.
Are you interested in Active Duty or Army Reserves?
Name:
Age:
Place of birth:
Height and Weight:
Full Address (street, city, zip):
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Marital Status:	Single Married Never Married Divorced Separated
Please check the highest level of education:	Currently in high school GED High School Diploma Some College Associates Degree Bachelor's Degree Masters
Are you currently taking any medication?	Yes No
Have you ever been diagnosed with ADD or ADHD?	Yes No
Have you ever had Asthma or used an inhaler?	Yes No
Do you currently wear glasses or contacts?	Yes No
Do you have Tattoo's, ear guages, or body piercings?	Yes No
Please explain any of the above yes answers:
Have you ever had a charge dismissed, set aside, or expunged?	Yes No
Are you currently awaiting trial or do you have unpaid fines?	Yes No
Have you ever been charges with a felony?	Yes No
Have youe ver been charged with a crime pertaining to drugs or alcohol?	Yes No
Have you ever been charged with a crime involving violence?	Yes No
Please explain any yes answers here:
Have you ever served in the Army or any of the other branches of service?
Have you ever tried to join another service (test or physical) if so what did you do and with which service?
How did you find out about this site?
Do you now have any questions or concerns that I can be prepared to answer for you?
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