ROGRAM/DESIG: (02)13950/(02)13957

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                   1135 SPECWAR              14X5 EDO                    1515 AEDO            1525 AMDO           1655 PAO
                   1605 IP                   1625/65/75 MER MAR          16X5 IW              1635 INTEL          1145 EOD
                   1805 OCEANO               3165 SUPPLY                 5105 CEC             1205 HR
ATTENTION All NAVCRUITDISTs: 40 pages shall be the maximum number of pages sent in one (1) file attachment. Documents, e.g. EPSQ, Physical,
etc., shall not be split between attachments or faxes. The Application Processing and Summary Record is the only acceptable fax cover sheet for all
faxes or attachments. NOTE: The file size shall be checked before the document is sent out. Files will not be accepted if the size limit, 1MB or 1000KB,
is exceeded. All items must be maintained until applicant has Final Disposition. After final disposition, must place required items in Residual File.
NAME:                                                        DESIGNATOR:
NAVCRUITDIST PROC:                                           NAVCRUITDIST:
                                     PROFESSIONAL DOCUMENTS/EXPLANATION (See Note 1)
#     YES   N/A
                                                 INTER-SERVICE TRANSFER (See Note 2)
                                                            BASIC APPLICATION
001                Application Checklist (NC 1131/21)
002                Application Processing and Summary Record (NC 1131/1)
                   Verified against CIRIMS: Correct Name:          Yes     SSN:     Yes      DOB:     Yes        Age:    Yes
                   Program Designator requested:        Yes.
003                Application for Commission (NC 1131/2)
                   Designator matches Application Processing Summary Record & CIRIMS            Yes
                   Meets requirements for Third class swim test       Yes   No, if NO, provide statement in remarks
004                EPSQ (SF 86) signed and dated by applicant within past 6 months (Refer to COMNAVCRUITCOM NOTE 5510) (See
                   Note 3)
005                Birth Certificate or Request Verification of Birth (DD Form 372) if original birth certificate unavailable
006                Evidence of Citizenship Form (NC 1100/25) (if naturalized)
007                Social Security Card Issued by Social Security Administration (SSA) or DD Form 214 or Report of Separation and
                   Record of Service for Prior Army or Air National Guard Members (NGB Form 22)
                                                         ACADEMIC INFORMATION
008                Copies of Official Transcripts include all front and reverse sides for each college attended (See Note 4)
                                                         PERSONAL INFORMATION
009                Resume / Curriculum Vitae signed and dated by applicant
010                Professional Community Interviewer’s Appraisal Sheet (NC 1131/5) (See Note 5)
011                Employment References DD Form 370, front and back pages (1 from each
                   employer for the last 3 years, including part-time employment)                          Minimum combined total of 3
012                Character References DD form 370 required if 3 employment references are not            valid references required
                   available. Using DD Form 370 is optional as long as all information on the form is
013                Photograph, full-length, 5x7 or 8x10 (PAO Only)
                                                      PRIOR SERVICE INFORMATION
014                DD 214(s) and or Point Capture If prior active/reserve service
015                Conditional Release (DD 368) for all other Military services and Navy enlisted. (See Note 6)
016                CO’s Recommendation for SELRES and Active Duty applicants
017                Prior Service Record Request (NC 1070/1)
018                Prior Service Record fitreps/evals, any derogatory information and cdrom record required
                                                      MISCELLANEOUS DOCUMENTS
019                Change of Name Statement (NC 1131/14) or provide copy of court documents/marriage license if using name other
                   than on birth certificate.
020                Family Care Plan Certificate (NP 1740/6) must include if single parent or dual military as applicable
021                Dual Compensation & Waiver Claim Statement (NC 1100/26) required if “yes” responses to questions 20a. & 20b.
                   of Sec I of Application for Commission
022                Maximum Age Statement of Understanding (NC 1131/54) (age 39 and older)
023                Letter of Understanding for 1465 applicants (NC1131/229)
024                Letter of Understanding for 3165 applicants (NC1131/228)
025                Special Warfare Group Endorsement (1135 only)
026                Professional Engineer License or Engineer in Training Certificate (1465,1515, 5105 only)
027                Copy of all licenses for 16XX Merchant Marine applicants
028                Official ASTB (OAR Only) scores report from NOMI or printout from (1635 only)

                                             For Official Use Only When Filled In

CHECKLIST (Rev 4-10)                                                                                                       Page 1 of 2
029               United States Navy Tattoo Screening Certificate (NC 1130/104) if applicable
030               Police Record Checks (DD 369) Submit if derogatory information noted on application
031               Disclosure of SSN Privacy Act Statement (NC 5211/1)
032               Statement of Understanding for Security Investigation (NC 1070/613)

         ________________________________________                       ________________________________________

         Signed/Date                                                    OPO Signature/Date

         Person Completing Checklist

Note 1: All copies should be “Certified as a True Copy” to ensure that the original was cited, and “Reproduced for Reference Purposes
        Only” written or typed in a conspicuous location.

Note 2: All Inter-Service Transfer packages are sent directly to PERS 911 for processing. For current requirements, please refer to

Note 3: EPSQ (SF86) is required for applicants that do not currently possess a security clearance. For those with a security clearance,
        JCAVs printout is required.

Note 4: Transcripts can be electronic version but must be printed in the Recruiter's presence and signed/dated by an Officer Recruiter
        (rank of O-1 or above) and certified to be a true copy. If classes taken at a prior school are listed with the class name and
        grade on the degree transcript, that is acceptable for those classes. Otherwise, applicant must request transcript for those
        classes (applicant/recruiter cannot just state the number of credits/hours transferred to school granting degree).

Note 5: All DCO Programs require two interviews minimum. At least one interview is required by an officer in the same designator, rank
        O-4 or above. Follow exceptions below.
        Exceptions: (1) 1635 require a Pre-nomination Personal Interview to be conducted by a RIPO or local
                        Special Security Officer (SSO) and a panel endorsement interview letters.
                    (2) 3165 requires two Supply Corps interviews by O-4 or above.
                    (3) 1465 requires three Engineering Duty Officer interviews by O-3 or above.

Note 6: Conditional release will be required along with the Final documents upon selection.

                                              For Official Use Only When Filled In

CHECKLIST (Rev 4-10)                                                                                               Page 2 of 2

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