Personal Data Sheet – Fill Out and Use This PDF

NAME : _________________________ RANK : ______

DOR : _________________ SSN : __________________

BASD : ________________ ETS : __________________

DOB : _________________ MOS : _________________

TIG : __________________ TIS : __________________

PROMOTABLE : YES / NO POINTS : _____________

WEIGHT : ________ HEIGHT : ________ HAIR : ___________ EYES : ___________ AGE : ____________

MARITAL STATUS : MARRIED / SINGLE / DIVORCED / SEPERATED

SPOUSE’S NAME : ________________________________

EFMP : YES / NO

CHILD’S NAME : _________________________________

AGE : ____

MALE / FEMALE

EFMP : YES / NO

CHILD’S NAME : _________________________________

AGE : ____

MALE / FEMALE

EFMP : YES / NO

CHILD’S NAME : _________________________________

AGE : ____

MALE / FEMALE

EFMP : YES / NO

CHILD’S NAME : _________________________________

AGE : ____

MALE / FEMALE

EFMP : YES / NO

HOME PHONE : __________________________

ADDRESS : _____________________________________________

RELIGION : ___________

BLOOD TYPE : ___

WEAPON # : _______

WEAPON SERIAL # : ____________

MASK # : _________

INSERT REQUIRED : YES / NO

DATE NBC PROF : __________

CONF : __________

DATE WEAPON QUAL : ______________

TYPE : _____________

QUALIFIED : MARK / SHARP / EXPERT

DATE LAST APFT : _____________

SCORE : _______ PUSH-UP : ____ SIT-UP : ______ RUN : ________

DATE WEIGH-IN : ___________

BODY FAT % : _____

PROFILE : T / P _______________________________

DATE CTT TEST : ___________

GO / NOGO

DATE DRIVERS TRAINING : ___________________________

DATE QUALIFIED CREW SERVED WEAPON : ____________ TYPE/S : _________________________________

NBC SUIT SIZE : _______

MASK SIZE : __________

BDU COAT SIZE : ______ TROUSER SIZE : _______

HAT SIZE : _______

BOOT SIZE : _____

DATE PLDC : _____

BNCOC : _________

ANCOC : _________

AWARDS: __________________________________________________________________________________________

DATE LAST GCM : _____________

DATE LAST NCOER : ___________

NEXT OF KIN : _________________

ADDRESS : ____________________________________________________ PHONE NO. : _____________________

POV MAKE : ___________________

MODEL : ________________________________________________________

YEAR : ________________________

COLOR : _______________________

LIC PLATE # : __________________

POST DECAL # : ________________

INS COMPANY : ________________

EXP DATE : ____________________

ANTHRAX SHOT # : _____________________________

ANTHRAX DATE : _______________________________

REMARKS