Page 3 of 3
SECTION IV - PERSONAL BACKGROUND QUESTIONAIRE
(All Applicants Must Complete) Utilize the Continuation/Remarks section to fully explain any "YES" answers (except 9 & 10). YES NO Attach a seperate sheet of paper if more space is necessary.
1. Within the last five years, have you been fired for any reason?
2. Within the last five years, have you quit a job after being notified that you would be fired?
3. Have you ever been convicted, forfeited collateral, or now under charges for any felony or firearms or explosives offense against the law?
4.During the past seven years, have you been convicted, imprisoned, on probation or parole, or forfeited collateral or are you now under charges for any offense against the law not included in Question 3?
5. While in the military, have you ever been convicted by a General Court Martial?
6. Does the United States Government employ, in a civilian capacity or as a member of the Armed Forces, any relative of yours by blood or marriage?
7.Do you receive or are you entitled to receive federal, military retired or retainer pay, service annuities, or other compensation based upon military, federal, civilian service, or eligible for immediate federal civil service?
8. Have you ever been removed from military service due to unsuitability?
9.Will you be able to complete a minimum of 5 years of continuous AGR Service prior to completing 18 years of Active Federal Service or your Mandatory Removal Date (MRD)?
10.Are you a candidate for an elected office, holding a civil office (full or part-time) or engaged in partisan political activities as defined in
AR 600-20/ANGI 36-101/DoD Directive 1344.10, Political Activities by Members of the Armed Forces on Active Duty?
11.Have you been involuntarily removed from unit (Selected Reserve) service based on maximum years of service, qualitative retention or selective retention board action?
12.Have you been involuntarily removed from unit (Selected Reserve) service for cause or been relieved for cause from any duty assignment, including but not limited to relief from command in the past year?
13. Do you currently possess or is a report of suspension of favorable actions pending?
14. Have you voluntarily separated from the AGR Program in any state for one or more days within the past year? (ARNG Applicants Only) 15. Have you been voluntarily separated from the AGR Program or voluntarily separated in lieu of adverse action?
16.(OFFICERS AND WARRANT OFFICERS ONLY.) Have you been non-selected for promotion as not best qualified for promotion board convened by Headquarters, or Department of the Army Headquarters, within the past 12 months?
17. Have you met the minimum requirement for each fitness component by scoring an overall score of 75 points or higher, per AFI 36-2905.
SECTION V - CONTINUATION/REMARKS
Use the Continuation/Remarks section to fully explain any "YES" answers (except 9 & 10). Attach a seperate sheet of paper if more space is necessary.
SECTION VI - CERTIFICATIONS AND AUTHORITY FOR RELEASE INFORMATION
I have completed this application with the knowledge and understanding that any or all items contained herein may be subject to investigation. I consent to the release of information concerning my capacity and fitness by employer, educational institution, law enforcement agencies, and other individuals and agencies to personnel specialists for purpose of employment. I also understand that a false answer to any question in this application may be grounds for not being employed, or for being released after I begin work.