ROGRAM/DESIG: (02)13950/(02)13957 - DOC by z6chY8

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									                                               FLEET OFFICER APPLICATION CHECKLIST
                                       PRIVACY ACT NOTIFICATION
This document contains information covered under the Privacy Act of 1974, 5 USC 552a and its
various implementing regulations and must be protected in accordance with those provisions. You,
the recipient/user, are obliged to maintain it in a safe, secure and confidential manner. Re-
disclosure without consent or as permitted by law is prohibited. Unauthorized re-disclosure or
failure to maintain confidentiality subjects you to application of appropriate sanctions. If you
have received this correspondence in error, please notify the sender immediately and destroy any
copies you have made.
NAME:                                COMMAND:                    DATE OF BIRTH:
SSN:                                 PROCESSOR:                  AGE:
DESIGNATOR APPLYING FOR
  01-1160 SWO                01-1190 EOD               01-3100 SUPPLY           02-1390 PILOT
  01-11601 SWO NUC           01-1640 CRYPTO            01-5100 CEC              02-1520 AMDO
  01-11701 SUB NUC           01-1650 PAO               02-1370 NFO              02-1630 INTEL
  01-1180 SEAL

ASTB SCORES: OAR______ AQR______ PFAR______ FOFAR_____
POC FOR SCORES: jeanmoore@nomi.med.navy.mil
JPAS POC: thomas.house@navy.mil
                                     PROFESSIONAL DOCUMENTS/EXPLANATION
 #  YES N/A
                                                  BASIC APPLICATION
001         Application Checklist (NC 1131/56)
002         OPNAV 1420.1A - Officer Programs Application
003         PRT Coordinator’s name printed and signed on Page 2 of application.
004         Security Manager’s name printed and signed on Page 5 of application. Question 35 initialed by member.
005         Applicant’s signature on Page 6 of application
006         Commanding Officer’s signature on Page 10 of application
007         Financial Statement completed (Page 14 of Application)
008         Officer Interviews. Must have minimum of 3 interviews to include one interview for each designator applying for.
            CEC applicants must have interview from CEC Accessions officer
009         Birth Certificate or   Request Verification of Birth (DD Form 372) if original birth certificate unavailable
010         Evidence of Citizenship Form (NC 1100/25)
011         Official Transcripts: Degree Earned:_____________________ GPA:__________ School____________________
            Engineering Degree must be from a ABET accredited school when applying for CEC
012         Copies of last 3 evaluations. Note: Some applicants have not been in the Navy long enough for 3 evaluations
013         Request ASTB – result letter from NOMI. POC is jeamoor@nomi.med.navy.mil
014         Request JPAS – submit printout of JPAS
                                                       PILOT/NFO
015         Anthropometric Measurements (NC1131/12)

                                                              EOD/SEAL
016                  EOD physical fitness test (NC1131/6)
017                  SEAL physical fitness test (NC1131/6)
                                                     NUCLEAR POWER SUB/SWO
018                  ACT/SAT SCORES
019                  Nuclear Power Pre-Service Drug Abuse Statement
020                  Nuclear Power Security Questionnaire if applicant or any family members are not US citizens by birth
                                                 MEDICAL DOCUMENTS/EXPLANATION
#     YES   N/A
021                  Report of Medical Examination (DD 2808) include all attachments & consults, must be less than 2 years old and
                     signed by credentialed provider DATE of PHYSICAL EXAM
022                  Report of Medical History (DD 2807-1) must be less than 2 years old and signed by credentialed provider
023                  EKG with interpretations
024                  Color vision for Pilot and NFO applicants
025                  Depth Perception for Pilot
026                  HIV and LAB results
                                                           st
027                  Eye Surgery- need all paperwork from 1 visit to completion
            ________________________________________       ________________________________________

            Printed/Date                                  Signed/Date
                                                          Person Completing Checklist
                                              For Official Use Only When Filled In


CHECKLIST (Rev 1-06)                                                                                  Page 1 of 1

								
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