Jfhqin Igr Form 1R PDF Details

The JFHQIN-IGR Form 1R, as laid out in Regulation 10-4, effective from 1 October 2007, serves as a comprehensive document for individuals seeking appointment or enlistment in the Indiana Guard Reserve. It aims to gather detailed information from applicants, ranging from personal data to their medical history, educational background, and prior military service. The form requires applicants to state their desired rank—officer, warrant officer, or enlisted—and provide supporting documentation for claims made throughout the application. This includes proof of citizenship, details of past military service evidenced by forms like the DD Form 214 and NGB Form 22, medical records, and educational achievements. Also integral to the application is the disclosure of any criminal records, substance abuse, or medical conditions that could impact the applicant’s service. By mandating such exhaustive information, the JFHQIN-IGR Form 1R ensures that candidates are thoroughly vetted for eligibility and suitability for roles within the Indiana Guard Reserve, underlining its commitment to maintaining high standards for its members.

QuestionAnswer
Form NameJfhqin Igr Form 1R
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesindiana guard reserve uniforms jfhq igr regulation 10 4, NBC, CDL, martialed

Form Preview Example

JFHQIN­IGR Reg 10­4

1 October 2007

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

INDIANA GUARD RESERVE

 

 

DATE: _____________________________

 

 

(Day)

(Month)

(Year)

FROM: ________________________________________________________________________________________________

(Last Name)

(First Name)

(Middle Name)

 

FOR: Commander, Indiana Guard Reserve, 2002 South Holt Road, Indianapolis, IN 46241­4839

1.Under the provisions of JFHQIN­IGR Regulation 10­4, I hereby apply for entry in the Indiana Guard Reserve, as an

_____(Officer), _____ (Warrant Officer), or _____ (Enlisted)

2.In connection with the application, I submit the following information, which I certify to be correct to the best of my knowledge and belief.

a. Home Address: __________________________________________________________________________________

(Number and Street)(City)

_____________________________________________________________________________________________________

(County)(State) (Zip Code + 4)(Area Code + Phone Number)

Email: _________________________. Cell #: ________________. Fax #: ________________.Pager#: ________________.

b.Place of Employment: __________________________________________________________________________

c.Employer Address: ______________________________________________________________________________

(Number and Street)(City)

_____________________________________________________________________________________________________

(County)

(State)

(Zip Code + 4)

(Area Code + Phone Number)

d.Present Occupation: _________________________________________ Years Experience: __________________

e.Other occupational background and years of experience: _____________________________________________

_____________________________________________________________________________________________________

f.Person to Contact in Case of Emergency: __________________________________________________________

(Name)

_____________________________________________________________________________________________________

(Address)(City, State, Zip + 4)

_____________________________________________________________________________________________________

(Area Code + Phone Number)

(Relationship)

JFHQIN­IGR Form 1R (1 October 2007)A­1 (Supersedes JFHQIN­IGR Form 1R dtd 1 November 2006)

1 October 2007

JFHQIN­IGR Reg 10­4

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

e.SSN: __________________ DOB: _____________________ Place of Birth: ______________________________

e.Height: _______ Weight: ______ Blood Type: _________ Color Hair: ___________ Color Eyes: ______________

e.Are you a citizen of the United States? ____. Yes ____. No If yes, by birth or by Naturalization? _________. (If naturalized, attach proof, which provides date and location.)

e. Marital Status:____ Single ____ Married ____ Separated ____ Widow/Widower ____ Divorced

e.Membership In professional societies: __________________________________________________________

e.Are you now a member of the Army, Navy, Air Force, Coast Guard, National Guard, Reserve, Civil Air Patrol, or State Defense Force of another State, in an active or inactive status? ____Yes ____ No (if yes, give details).

e.Is your service obligation completed? ____ Yes ____ No If no, when will it be completed: _______________

e.Have you ever been rejected for military service? ____ Yes ____ No If yes, state when, where, and

reason rejected: _______________________________________________________________________________________

e.Are you receiving a disability allowance, disability retirement pay, or pension as a result of military service?

_____ Yes _____ No

If yes give details: _____________________________________________________________

e.Have you ever used cocaine, heroin, morphine, or any narcotic not legally prescribed by a physician, had a venereal disease, convulsions or fits, or spells of unconsciousness, or had any mental illness that required professional medical treatment? ____ Yes ____ No If yes give details: _______________________________________

JFHQIN­IGR Form 1R (1 October 2007)

A­2

JFHQIN­IGR Reg 10­4

1 October 2007

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

e.To the best of your knowledge and belief, regarding your physical and mental health, are you now

sound and well? _____ Yes _____ No If no, give details: ______________________________________________

e.Have you ever been treated for alcoholism? _____ Yes _____ No If yes give details: _____________________

e.Have you ever been reclassified/reassigned while in the military service in lieu of court martial? Proceedings? _____ Yes _____ No If yes give places and details: ____________________________________________

e.Have you ever been court martialed? ____ Yes ____ No If yes, give details (date, place, charge, and

details): ______________________________________________________________________________________________

e.Have you ever been arrested and convicted for other than minor traffic violations? _____ Yes _____ No

If yes, give details: _____________________________________________________________________________________

e. Education:

 

 

(1) Civilian: (list only accredited colleges/universities)

No. Years

Graduated

Name of School

Attended

Yes / No

JFHQIN­IGR Form 1R (1 October 2007)

A­3

1 October 2007

JFHQIN­IGR Reg 10­4

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

e.Military:

Name of School

Location

Date

e.Record of Military Service. (Attach a legible copy of DD Form 214, NGB Form 22, Reserve Release Order, to show proof of each period of service indicated. Other documents from military service may be included.) Chronological record of military service (Army, Navy, Air Force, Marine Corps, Coast Guard, Reserve, Indiana Guard Reserve, State Defense Force of another state, etc.)

Dates (Month & Year)

From

To

Grade

Organization

Duty Performed

JFHQIN­IGR Form 1R (1 October 2007)

A­4

JFHQIN­IGR Reg 10­4

1 October 2007

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

3.Medical History:

e. Personal Physician: ___________________________________________________________________________

(Name)

(Location)

(Area Code + Phone Number)

e.Hospital: _____________________________________________________________________________________

(Name)

(Location)

(Area Code + Phone Number)

e.Medical Conditions: ___________________________________________________________________________

e.Medications: _________________________________________________________________________________

e.Allergies: _____________________________________________________________________________________

e.Past Medical Treatment: ________________________________________________________________________

e.Remarks ­ Any other information you may desire to submit:

e.The following documents are attached: (Check each item that applies)

ITEM NUMBER:

____1. * Birth Certificate. (Not required if DOB is verified by documents in item 3 below).

____2. Proof of Naturalization. (if applicable)

____3. Proof of Service. (DD Form 214, NGB Form 22, Reserve Release Orders.). (Document ALL periods served).

____4. Last 3 copies of OER, EER, and/or Equivalent Forms.

____5. License to Practice and/or Certificate. Copy of Degree and/or transcript.

____6. Ecclesiastical Endorsement.

____7. Personal Resume. (Officer candidates must state what they offer the IGR)

____8. Diplomas (Any schools)

____9 * Photograph

___ 10. * Skill Assessment Form

e.Required item. NOTE: Attach documents to verify all checked items. Failure to do so will delay your application processing.

JFHQIN­IGR Form 1R (1 October 2007)

A­5

1 October 2007

JFHQIN­IGR Reg 10­4

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

6.a. I understand that membership in the Indiana Guard Reserve does not entitle me to the use of federal facilities or any federal benefits at any military Installation.

e.I understand that I must obtain permission from The Adjutant General in advance in order to wear the Indiana Guard Reserve Uniform outside the State of Indiana.

e.I am not now a current member or associated with any unorganized Militia/Extremist group.

e.I have never been convicted of a Misdemeanor Crime of Domestic Violence under I.C. 35­42­2­1 after 30 September 1996, and that I do not have any Domestic Violence charges currently pending.

e.I affirm that the above is true and correct to the best of my knowledge and belief, and I understand that any false statement, willful misrepresentation, or concealment as to qualification for Appointment or Enlistment in

the Indiana Guard Reserve makes me liable to have appropriate action taken against me for fraudulent entry and may result in immediate administrative discharge.

__________________________________________________________________________________________

(Signature of Applicant)

(Date Signed)

JFHQIN­IGR Form 1R (1 October 2007)

A­6

JFHQIN­IGR Reg 10­4

1 October 2007

APPENDIX A

APPLICATION FOR APPOINTMENT OR ENLISTMENT

CRIMINAL BACKGROUND CHECK REQUIRED FOR ADMISSION TO THE

INDIANA GUARD RESERVE

Your interest in serving in the Indiana Guard Reserve is greatly appreciated. However, enlistment or commissioning in the Indiana Guard Reserve is not a right.

Considering Indiana Guard Reserve mission requirements and the present world threat of terrorism, increased security is required. Therefore, all persons applying to serve in the Indiana Guard Reserve must undergo a criminal background check as part of the application process. The Indiana Guard Reserve will pay the cost for such a background check if it appears that you otherwise may qualify.

If you wish to apply to the Indiana Guard Reserve, you must give your permission to the Indiana Guard Reserve to obtain a criminal background check. The information from this criminal background check will be confidential and only used for purposes of your application to the Indiana Guard Reserve. This permission to obtain a background check will become null and void ninety (90) days after the date of your written permission.

If you are not admitted to the Indiana Guard Reserve because of adverse information in the background check, you will be so informed and given the reason. However, as you did not pay for the background check, you will not be given a copy of it, but you will be given the information necessary for you to obtain it yourself.

PERMISSION TO OBTAIN A CRIMINAL BACKGROUND CHECK

I, ___________________________________________________, hereby give my permission to the Indiana Guard

Reserve, Military Department of Indiana, Indianapolis, Indiana, to obtain a criminal background check concerning me as part of my application process for enlistment or commissioning in the Indiana Guard Reserve.

I understand this background check will be treated as confidential information and only for application purposes to the Indiana Guard Reserve, and further, that this permission will become null and void ninety (90) days after the below stated date.

_________________________________________

Signature

_________________________________________

Printed Signature

_________________________________________

Date

JFHQIN­IGR Form 1R (1 October 2007)

A­7

JFHQIN­IGR Reg 10­4

1 October 2007

 

APPENDIX A

 

APPLICATION FOR APPOINTMENT OR ENLISTMENT

 

ENDORSEMENT – 1

 

To be completed by: Unit Commander

I have reviewed this application for ____ (Appointment), ____ (Enlistment) and Recommend:

_____Approval

_____Disapproval

Request Applicant be appointed or enlisted in Para/Line #: _______________________________ in T.O. position:

(Duty Title): _______________________________________________. (Unit): __________________________________

Person to be given credit with recruitment of Applicant:

Name: ____________________________________________. Rank: ________. Unit: __________________________

____________________________ _____________________________________________________________

(Date)

(Signature of Unit Commander)

 

ENDORSEMENT – 2

 

To be completed by: Brigade Commander or Equivalent

I have reviewed this application and ____ (CONCUR), ____ (NONCONCUR) with the recommendation.

____________________________

_________________________________________________________

(Date)

(Signature of Brigade Commander/Equivalent)

 

ENDORSEMENT – 3

To be completed by: Board President in­lieu of Endorsement 1 thru 2.

The Personnel Action Board has reviewed this application and ____accept, ______ do not accept, applicant into the

IGR. Individual will be assigned to _________ Command.

____________________________

_________________________________________________________

(Date)

(Signature of Board President)

JFHQIN­IGR Form 1R (1 October 2007)

A­8

JFHQIN­IGR Reg 10­4

1 October 2007

 

APPENDIX A

SKILLS ASSESSMENT

NAME:

 

 

 

 

 

 

SSN: (last 4 nbrs)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Address:

 

 

 

 

 

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date completed

 

 

 

 

 

Present Occupation

 

 

 

 

 

 

 

 

Trades:

Computer:

Enforcement/Protection

 

Medical

 

Bricklayer

 

Repair

 

 

Police Officer

 

 

 

 

Doctor

 

Carpenter

 

Programmer

 

 

Instructor

 

 

 

 

EMT

 

 

 

 

 

 

Data Entry

 

 

Fire Fighter

 

 

 

 

Nurse

 

Plumber

 

Personal Use

 

 

Private Security

 

 

 

 

PA

 

HAVAC

 

 

 

 

Guard

 

 

 

 

Optometrist

 

 

 

 

 

 

 

 

 

 

 

 

Concrete worker

 

 

 

Foreign Language

 

 

 

 

Chiropractor

 

 

 

 

 

Transportation

 

 

Spanish

 

 

 

 

Pharmacist

 

 

 

 

 

 

Private Pilot

 

 

Arabic

 

 

 

 

Dentist

Teacher

 

Truck Driver (CDL)

 

 

French

 

 

 

 

Dental Assistant

 

Elementary

 

Bus Driver (CDL)

 

 

German

 

 

 

 

 

 

 

 

 

School

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle School

 

Dispatcher

 

 

Japanese

 

 

 

 

 

 

 

 

 

High School

 

HAZMAT End

 

 

 

 

 

Communications

 

College/

 

Mechanic

Business Office

 

 

 

 

Amateur Radio Lic

 

university

 

 

 

 

Management/Ad

 

 

 

 

CB Radio

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

min

 

 

 

 

 

 

 

 

Military (include IGR)

Military Drivers License

 

 

Secretary

 

 

 

 

 

 

 

 

 

Instructor

 

Sedan

 

 

Clerk

 

Civilian Education

 

MP

 

Bus

 

 

Public Speaking

 

 

 

 

High school

 

Operations

 

 

 

 

HR

 

 

 

 

Associate Degree

 

Intelligence

 

 

 

 

Contract Writer

 

 

 

 

Baccalaureate Degree

 

Logistics

 

 

 

 

 

 

 

 

 

 

Master Degree

 

Administration

Hazardous Materials

Legal

 

 

 

 

Law Degree

 

Security

 

NBC

 

 

Attorney

 

 

 

 

Medical Degree

 

Communications

 

WMD

 

 

Paralegal

 

 

 

 

Prof Engineer (PE)

 

 

 

 

 

 

HAZMAT

 

Equipment Operator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Pertinent

 

 

 

 

Fork Lift

 

Other Occupation not listed

Information

 

 

 

 

Bulldozer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Road grader

 

 

 

 

 

 

 

 

(Note: This form is removed and forwarded for input into a computer database.)

JFHQIN­IGR Form 1R (1 October 2007)

A­9