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First Name

Last Name

Email Address

Mobile Number

Position you’ve Applying for :

If you're certified for any of the following, please enter the date of certification or graduation

JSOMTC Graduate

Pararescue Apprentice (PJ) Course

NRA certified

Federal Firearms Instructor (FFI)

USN Small Arms Training Instructor

USAF Combat Arms Training and Maint Instructor

USMC Primary Marksmanship Instructor

Sniper school, USArmy

Sniper school, USMC

Sniper school, SF Sniper Course

Sniper school, MARSOF Advanced Sniper Course

Sniper school, USN SEAL Sniper School

SFAUC

SFARTAETC

USMC EOTG CQT Course

Military Instructor School

MARSOC CQC

OTC

Driving : If you're applying for a
position
as driving
instructor, please enter the number of years of experience as an instructor:

Special Reconnaissance : If you're
applying
for a
position as Special Reconnaissance instructor, please enter the name of the course you took and
your graduation date:

Course name

Breaching: If you're applying for a
position as
breaching instructor, please enter the name of the course you took and your graduation
date:

Course name

Medical credentials For any medical credentials, fill out, if available, your
registration number or ID and expiration date:

NREMT-P

BLS

ACLS

PALS

PEPP

BTLS

FPC

TCCC

BLS Instructor

ACLS Instructor

TCCC Instructor

EMT-B

EMT-I

EMT-T

State Paramedic License

ATP

Nurse

Physician Assistant

Physician (MD/DO)

Military & Misc Data:

MOS/NEC

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Last Rank

Clearance Achieved

Military Status

Date of Separation

WPS Bio Approval : for any WPS bio you have
fill out the date, subject matter and clearance holder.

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Education level

Secondary languages ( other than
English )
For each language please enter the name and your proficiency (get by, good, native). Start
each
on its own line.

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