Direct Accession 2200   Dental Recall 22001  Dental FAP 22053 Dental HSCP 22007
                               Dental Student 1925    Dental HPSP 1985     Reserve 2205

ATTENTION All NAVCRUITDISTs: Documents should be attached into O’Tools per the Web O’Tools Standard Operating Procedures.

NAME:                                                  SSN:              DESIGNATOR:
NAVCRUITDIST PROC:                                              NAVCRUITDIST:
                                             PROFESSIONAL DOCUMENTS/EXPLANATION
#     YES   N/A
                                                        SCROLL & AFIP SUBMISSION
001                 Scroll Pre-Screening Form (NC 1131/67) submitted to CNRC via OPO
002                 Submitted to AFIP 2200 and 2205 AFIP Checklist available in Info Center in O’Tools.
                                                             BASIC APPLICATION
003                 Application Checklist (NC 1131/62)
004                 Application Processing and Summary Record (NC 1131/1)
005                 Application for Commission (NC 1131/2) Not required for RECALL applicants
                    Designator matches Application Processing Summary Record            Yes
                    Dependent Travel Statement of Understanding Initialed         Yes
                    Meets requirements for Third class swim test       Yes     No, if NO, provide OPO statement to applicant
006                 Security Clearance: Does applicant have a current NACLC or higher in JPAS            Yes    No; if yes must submit
                    printout of JPAS with kit (cannot be greater than 10 yrs). If no must submit the EPSQ (SF 86) signed and dated by
                    applicant within past 6 months (Refer to COMNAVCRUITCOM NOTE 5510). Submit to OPM at time of Physical.
007                 Birth Certificate or        Request Verification of Birth (DD Form 372) if original birth certificate unavailable
008                 Evidence of Citizenship Form (NC 1100/25) if naturalized
                                                   RECALL (Note: Not eligible if FOS x2)
009                 Application for Recall to Ext Active Duty (NP 1331/5) prior commission any service
010                 Security Summary (NC 1131/2 sec IV)
011                 Military Service Summary (NC 1131/2 sec V)
012                 Motivational Statement (NC 1131/2 sec VIII)
                                        ACADEMIC INFORMATION (Note: Not required for Recall)
013                 Copies of Official Transcripts include all front and reverse sides for each college attended (Important see Note 1)
014                 Academic Degree Completion Plan (NC 1131/4) (HSCP only) Ensure total hours blocks and required hours blocks
                    completed, applicant is enrolled full time Spring and Fall and signed by Dean/advisor.
015                 Academic Year Statement 1985. Not required for kit submission but required before FINSEL. NRD must submit to NMPT&E
                    with signed Commissioning Documents (Oath of Office & Service Agreement)
016                 GPA Calculation Worksheet (NC 1131/53) include all schools attended
017                 Professional School Entrance Exam Report (DAT) 2200, 2205, 22053, 22007, 1985 and 1925
018                 Letter of Acceptance to school/residency all students & FAP not yet attending school/residency Applicant for
                    dental school that has not started school yet will not receive a LOA before December of each year. The PM should be
                    forwarded these kits with the LOA pending. Applicants applying for 2 yr or 3yr programs should be able to provide
019                 Letter of Good Standing with school /residency 22053, 22007, 1985, 1925 and 2200/2205 applying as student.
                    Letter must include graduation date. (LOGS will be acceptable in place of a LOA for someone already in dental
                                                         PERSONAL INFORMATION
020                 Resume / Curriculum Vitae signed and dated
021                 Professional Community Interviewer’s Appraisal Sheet (NC 1131/5) 2 required for 2200, 2205, and 22053.
                    Student programs 22007, 1985, and 1925 on 1 required. (Important see note 2)
022                 Employment References DD Form 370 (1 from each employer for the last 3 years, Minimum combined total of 3
                    including part-time employment) (Important see note 3)                                valid references required
023                 Character References required if employment references are not available
024                 Instructor Reference
025                 Training Program Director Reference 2200, required when employment references are not available
026                 Health Professional Qualification Summary (NC 1131/11) 2200, 2205, and 22001 only
027                 Professional Certificate/License 2200, 2205, 22001 and 22053 as applicable, not required for student programs.
028                 DEA Certification 2200, 2205 and 22001
029                 License Verification (NC 1131/13) all states ever licensed 22001 and 22053
030                 Verification Conditions and Release Information (NC 1131/47) 2200/2205 only, signed and dated within 6 months.
031                 Evidence of Specialty Training/Specialty Clarification/Specialty Experience 2200 and 2205 only, if applicable

CHECKLIST (Rev 1-08)                                                                                                      Page 1 of 2
032                  Duty Preference for Medical Programs (NC 1131/16) 2200, 22001, three choices required
033                  Critical Skills Accession Bonus (CSAB) Accept / Decline Letter 1985 only
034                  Application Letter for Dental Corps Accession Bonus Program 2200 only
035                  Application for HPLRP 2200 and 22001, if eligible

#     YES     N/A                                PRIOR SERVICE INFORMATION
036                  DD 214(s) If prior active service/reserve service
037                  Conditional Release (DD 368) Navy Drilling Reserve and all non-Navy military
038                  CO’s Recommendation all Active Duty applicants
039                  Enlisted Personnel Action Request (NP 1306/7) active duty Navy enlisted only. (Important see note 4)
040                  Prior Service Record If prior service. (Important see note 5)
                                                       INTER-SERVICE INFORMATIOIN
041                  Letter of Inter-Service Transfer Request
042                  Contingent Resignation Letter if commissioned in another service
043                  Verification of Current Grade and Date of Rank statement must come from parent service
044                  Verification of no fails to select to next higher paygrade statement must come from parent service
                                                       MISCELLANEOUS DOCUMENTS
045                  Change of Name Statement (NC 1131/14) and provide copy of court documents/marriage license
046                  Family Care Plan Certificate (NP 1740/6) must include if single parent or dual military as applicable
047                  Dual Compensation & Waiver Claim Statement (NC 1100/26) required if “yes” responses to questions 20a. & 20b.
                     of Sec I of Application for Commission
048                  Police Record Checks (DD 369) Submit if any derogatory information noted on application
049                  Maximum Age Statement of Understanding (NC 1131/54)
050                  United States Navy Tattoo Screening Certificate (NC 1130/104) if applicable
051                  Disclosure of SSN Privacy Act Statement (NC 5211/1)
052                  Statement of Understanding for Security Investigation (NC 1070/613)

                                                       MEDICAL DOCUMENTS/EXPLANATION
053                  Report of Medical Examination (DD 2808) include all attachments & consults, must have HIV, drug & alcohol test
                     results DATE of PHYSICAL EXAM           Physical must not be older than 2 years.
054                  Report of Medical History (DD 2807-1)
055                  Privacy Act Statement for Health Care Records (DD 2005)
056                  Fingerprint Charts (FD258) Retain at NRD. (Important see note 6)

            ________________________________________                       ________________________________________

            Signed/Date                                                    OPO Signature/Date

            Person Completing Checklist

    1       Transcripts can be electronic version but must be printed in the Recruiter’s presence and signed/dated by an Officer Recruiter
            (in rank of 01 or above) to be a true copy. If classes taken at a prior school are listed with class name and grade on degree
            transcript do not need to request that transcript. Cannot just state number or credits/hours transferred.
      2     For 2200, 2205, and 22053: At least one (1) interview must be by an officer in same subspecialty for which applying; second
            interview may be from any officer (active, reserve or retired).
            For 22007, 1985, and 1925i: Only one (1) interview must be by a DC Officer (active, reserve or retired) needed if GPA is equal
            to or less than 3.0 and DAT is equal to or less than 20.
            Interviews cannot be from anyone in recruiting. General guidance: recommend O-4 or above unless otherwise negotiated with
            Specialty Leader/Program Manager. Annotate on NC1131/1 if negotiation made with SL/PM.
      3     If full-time employment has been with the military for the past 3 years applicant can use Evals/FITREPS.
      4     Active duty applicants applying for program must submit an NP1306, including message release from NPC (requesting
            conditional release). Once applicant is final selected, NRD must submit an NP1306 requesting discharge or release from
            active duty.
      5     For active duty send only fitreps/evals and any derogatory information.
      6     LIVESCAN of applicant fingerprints to be conducted by MEPS at time of physical.

                                           For Official Use Only When Filled In

CHECKLIST (Rev 1-08)                                                                                                  Page 2 of 2

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