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.
Question | Answer |
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Form Name | Jfhqin Igr Form 1R |
Form Length | 9 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 2 min 15 sec |
Other names | indiana guard reserve uniforms jfhq igr regulation 10 4, NBC, CDL, martialed |
JFHQINIGR Reg 104 |
1 October 2007 |
APPENDIX A
APPLICATION FOR APPOINTMENT OR ENLISTMENT
INDIANA GUARD RESERVE
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DATE: _____________________________ |
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(Day) |
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FROM: ________________________________________________________________________________________________ |
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(Last Name) |
(First Name) |
(Middle Name) |
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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: |
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(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 |
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APPENDIX A |
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APPLICATION FOR APPOINTMENT OR ENLISTMENT |
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ENDORSEMENT – 1 |
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To be completed by: Unit Commander |
I have reviewed this application for ____ (Appointment), ____ (Enlistment) and Recommend: |
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_____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) |
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ENDORSEMENT – 2 |
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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) |
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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 |
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APPENDIX A |
SKILLS ASSESSMENT
NAME: |
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SSN: (last 4 nbrs) |
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Home Address: |
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Email: |
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Date completed |
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Present Occupation |
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Trades: |
Computer: |
Enforcement/Protection |
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Medical |
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Bricklayer |
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Repair |
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Police Officer |
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Doctor |
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Carpenter |
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Programmer |
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Instructor |
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EMT |
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Data Entry |
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Fire Fighter |
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Nurse |
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Plumber |
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Personal Use |
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Private Security |
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PA |
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HAVAC |
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Guard |
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Optometrist |
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Concrete worker |
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Foreign Language |
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Chiropractor |
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Transportation |
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Spanish |
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Pharmacist |
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Private Pilot |
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Arabic |
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Dentist |
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Teacher |
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Truck Driver (CDL) |
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French |
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Dental Assistant |
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Elementary |
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Bus Driver (CDL) |
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German |
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School |
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Middle School |
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Dispatcher |
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Japanese |
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High School |
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HAZMAT End |
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Communications |
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College/ |
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Mechanic |
Business Office |
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Amateur Radio Lic |
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university |
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Management/Ad |
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CB Radio |
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min |
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Military (include IGR) |
Military Drivers License |
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Secretary |
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Instructor |
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Sedan |
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Clerk |
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Civilian Education |
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MP |
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Bus |
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Public Speaking |
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High school |
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Operations |
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HR |
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Associate Degree |
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Intelligence |
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Contract Writer |
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Baccalaureate Degree |
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Logistics |
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Master Degree |
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Administration |
Hazardous Materials |
Legal |
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Law Degree |
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Security |
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NBC |
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Attorney |
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Medical Degree |
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Communications |
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WMD |
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Paralegal |
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Prof Engineer (PE) |
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HAZMAT |
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Equipment Operator |
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Other Pertinent |
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Fork Lift |
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Information |
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Bulldozer |
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Road grader |
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(Note: This form is removed and forwarded for input into a computer database.)
JFHQINIGR Form 1R (1 October 2007) |
A9 |