4337 A Form PDF Details

The 4337 A form is required by the Department of Homeland Security, United States Secret Service for candidates applying to physically demanding law enforcement positions. It serves as a Certificate of Wellness, with a licensed physician certifying the applicant can safely complete the APAT physical examination.

The Applicant Physical Abilities Test (APAT) evaluates four areas of physical fitness:

Each APAT component has age-specific and gender-specific minimum benchmarks. Failing any single component results in disqualification from that testing round. Applicants who do not meet the standard may reapply after a waiting period.

The physician completing the 4337 A form must conduct a health history review and physical assessment. They confirm no conditions exist that would prevent the applicant from safely undergoing the fitness test. This includes reviewing cardiovascular health, musculoskeletal condition, and overall physical status. An annual physical examination may be required as supporting documentation.

The completed 4337 A form must be submitted before the scheduled APAT date. The Secret Service reviews the physician's certification as part of applicant screening. This form is one of several required documents in the U.S. Secret Service hiring process for special agent and officer positions.

QuestionAnswer
Form Name4337 A Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
PurposePhysician certification for APAT fitness test
Issuing AgencyU.S. Secret Service, Dept. of Homeland Security
Other namessecret service applicant physical abilities test, secret service physical test, applicant physical abilities test apat fitness standards, applicant physical abilities test

Form Preview Example

 

DEPARTMENT OF HOMELAND SECURITY

 

United States Secret Service

 

APPLICANT PHYSICAL ABILITIES TEST (APAT)

 

CERTIFICATE OF WELLNESS

Dear Physician:

 

Your patient,

, is applying for a physically challenging law enforcement position

with the United States Secret Service. Your patient requests that you certify him/her as physically capable of safely performing the United States Secret Service Applicant Physical Abilities Test (APAT) which consists of the following four components:

1)Push-ups (Minimum number of push-ups required to acquire points is 15.)

2)Sit-ups (Minimum number of sit-ups required to acquire points is 23.)

3)Illinois Agility Run (Minimum time required to acquire points is 23.88 seconds.)

4)1.5 Mile Run (Minimum time required to acquire points is 19 minutes, 40 seconds.)

The purpose of the APAT is to measure your patient's current level of general physical fitness, which serves as an indicator of his/her ability to safely complete a vigorous physical training program. Furthermore, the APAT introduces fitness standards that your patient will be required to maintain upon entry into a law enforcement position with the United States Secret Service, should your patient be offered such a position. If you agree to certify, please sign the attached Physician Certification Statement, and return the form to your patient for submission to the United States Secret Service.

PHYSICIAN CERTIFICATION STATEMENT

As a licensed physician, it is my professional opinion that my patient is physically capable of safely performing the components of the Applicant Physical Abilities Test (APAT). I understand that the APAT will be administered according to the protocols described in Attachment A.

SIGNATURE:

DATE:

PRINTED NAME OF LICENSED PHYSICIAN:

ADDRESS (include Street, City, and State):

PHONE NUMBER:

STATE LICENSE #:

SSF 4337A (05/2013)

Page 1 of 3

ATTACHMENT A

Push-ups

The purpose of the Push-ups assessment is to evaluate your upper body strength. This assessment will be administered in an indoor or outdoor space.

The starting position for this assessment requires your feet and hands to be in contact with the floor. Your feet must be 8 to 12 inches apart, your hands must be slightly wider than shoulder width apart, and your arms must be extended and straight. Your legs, buttocks, back, and shoulders should be in straight alignment.

To complete a push-up, bend your elbows and lower your torso until your elbows are flexed at a 90 degree angle. Once your elbows are flexed at a 90 degree angle, return to the starting position by straightening your elbows.

To ensure you have reached a 90 degree angle your chest must touch a foam block which will be placed directly under your chest. Once you reach a 90 degree angle, return to the correct starting position.

For this assessment, you will do as many push-ups as possible within a 60 second time period. You will be notified when there are 30 and 15 seconds remaining. You will be given only one trial.

Sit-ups

The purpose of the Sit-ups assessment is to evaluate your abdominal strength. This assessment will be administered in an indoor or outdoor space using a 24x70 inch floor mat.

You will be required to lie down on your back with your knees flexed to a 45 to 75 degree angle, feet placed flat on the floor, and your heels placed about 12 to 18 inches from your buttocks. A second person will assist you by holding your feet in place during the exercise.

You will be required to cross your arms over your chest, placing your hands on the opposite shoulders near your collar bone. Your arms must maintain contact with your chest at all times as you perform the sit-ups. Your chin should remain tucked onto your chest.

With each sit-up, you should curl your shoulders, keep your lower back on the ground until you have curled the upper back, and finally come to a position in which your elbows touch your thighs. You must be sure to curl your back, as this will force you to use your abdominal muscles and will keep you from straining your back. Before completing a consecutive sit-up, you must lie back down until your mid-back touches the floor mat.

For this assessment, you will do as many sit-ups as possible within a 60-second time period. You will be notified when there are 30 and 15 seconds remaining. You will be given only one trial.

SSF 4337A (05/2013)

Page 2 of 3

Illinois Agility Run

The purpose of the Illinois Agility Run assessment is to evaluate your anaerobic power and ability to change directions. This assessment will take place either indoors or outdoors and will require you to complete a short distance run with changes of direction as fast as possible.

To begin this assessment, you will be required to position yourself on your stomach, with fingertips placed at the edge of the start line in a quasi push-up position. Your head and shoulders may be positioned beyond the start line. Your feet must be positioned together with your ankles touching, while your toes are positioned such that you are resting on the balls of your feet.

Upon being given the command to start, you will move to your feet and begin running through the course. You must follow the marked outline of the course. The course requires you to start the assessment by running straight ahead for 30 feet, turn around the cone and back to the cone in the middle. Continue through the course by going to the left and around each cone in the middle. Then run back through these same cones. Finally, turn left and run up to the cone on the right and back and across the finish line.

You will be given two trials for this assessment, but only your best trial will be scored. A diagram of the course has been provided below for illustration purposes.

1.5 Mile Run

The purpose of the 1.5 Mile Run assessment is to evaluate your cardiovascular endurance. This assessment will take place either indoors or outdoors on a marked hard and flat surface with minimal sharp turns.

To begin this assessment, you will be required to stand at the start line of the course. Upon being given the command to start, you should begin running. You will be required to complete the 1.5 mile course to complete this assessment.

Your score is based on the time you complete the 1.5 mile run. Therefore, you should run as quickly as possible to improve your score on this assessment. You will be permitted to walk or stop during the run, however the timer calculating your run time will not be stopped. You will be given only one trial.

SSF 4337A (05/2013)

Page 3 of 3

How to Edit 4337 A Form Online for Free

To fill out the 4337 A form (also known as the USSS fitness test form), no software download is needed. Use FormsPal's free online PDF editor from any device. For related forms, see our adult physical form or annual physical examination form.

Step 1: Open the PDF Form

Press the orange "Get Form" button above to open the PDF tool and begin filling in your form.

Step 2: Complete the Form Fields

The editor lets you add text, correct existing content, and add a signature as needed. Complete each field carefully and accurately.

This PDF form requires specific physician information. Make sure the following sections are completed correctly:

1. The USSS fitness test form requires specific information. Make certain the following blanks are completed:

Step no. 1 in filling out us secret service physical test

2. After this section is filled out, enter the required information in: SIGNATURE, DATE, PRINTED NAME OF LICENSED PHYSICIAN, ADDRESS (Street, City), PHONE NUMBER, STATE LICENSE, SSF A, and Page of.

Step # 2 of filling in us secret service physical test

Double-check PRINTED NAME OF LICENSED PHYSICIAN and PHONE NUMBER, as these fields are often filled incorrectly.

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Review all completed fields and click "Done". Join for a free FormsPal trial to access and download your completed USSS fitness test form. Your file is saved to your FormsPal account. All personal information entered is kept private and secure.