Download:
pdf |
pdfBRIEFING ITEMS
PROCESSING PROGRAMS
Program/Subprogram
Officer Type
EA NPS
DEMOGRAPHICS
Lead Date
Prefix
Lead Origination
Briefed on the Privacy Act
Registered to Vote & ST
Briefed on Separation Policy
NPS Viewed BMT Film
Lead Source
20121217
Gender
No Lead Source Detail
Middle Name (if none enter NMN)
Qienpb
First Name
Ppeeki
Male
Last Name
Ackfmkbd
Verified SSN
320-88-8792
Suffix DOB
19930301
Age
20
Maiden Name / Alias Names
Citizenship U.S. AT BIRTH
Hair Color Brown
Racial Category CA
Eye Color Brown
Ethnic Category NOT HISPANIC OR LATINO
Religious Preference 00
1st Foreign Language None
2nd Foreign Language None
Selective Service Number 9211083895
Home Phone 907-927-5400
Cell Phone
Work Phone
Current Address
8412 Acvly Si. Fairbanks Fairbanks North Star AK 99709 US
Home of Record
8412 Acvly Si. Fairbanks Fairbanks North Star AK 99709 US
Personal Email py.hpd84@jgpnt.lvg
Valid Drivers License
Business Email
Present Occupation
Drivers License #
State
EXP Date
BIRTH VERIFICATION
City of Birth
County
State
Country
Fairbanks
Fairbanks North Star
AK
US
Naturalization #
INS # (Citizen Certificate)
INTERVIEW
Alien Registration #
CCMAPPEDDS
Y
REMARKS
Verification
N
Y
Citizenship
Prior Service
Conscientious Objector
Morals
Education
Dependents
Age
Drugs
Physical
SSN
Domestic Violence
Waiver(s) Required
Gov Credit Card
UIF
Malpractice
Sec. Clearance Req'd
N
Ppeeki Qienpb Ackfmkbd - 320-88-8792
Height/Weight History
Name: Ppeeki Qienpb Ackfmkbd
MEPS Height:
Open Data
20121217
SSN: 320-88-8792
Gender: Male
MEPS Weight:
Height (in)
68
Weight (lbs)
165
Min. Weight
125
Max. Weight
180
BFM
Remarks
Ppeeki Qienpb Ackfmkbd - 320-88-8792
MARITAL STATUS
Marital Status
Single
What document did you use to verify the Marital Status?
MILITARY SPOUSE
Spouse's SSN:
Spouse's paygrade:
Spouse's branch of service:
Spouse's current duty station:
Is military spouse the step-parent of any children in the applicant's custody?
DEPENDENTS
Number of Adult Dependents
0
Number of Minor Dependents
0
Expected Marital and/or Dependency Changes
What document did you use to verify the Single Signature Parental Consent?
RELATIVES (Check the relatives which are dependents)
LAST NAME
FIRST NAME
ADDRESS
LAST NAME
CITY
FIRST NAME
ADDRESS
LAST NAME
FIRST NAME
LAST NAME
FIRST NAME
LAST NAME
FIRST NAME
LAST NAME
FIRST NAME
LAST NAME
ADDRESS
STATE
STATE
STATE
FIRST NAME
STATE
ZIP
FIRST NAME
STATE
ZIP
STATE
DEPENDENT
COUNTRY
DEPENDENT
COUNTRY
DEPENDENT
RELATIONSHIP
ZIP
COUNTRY
DEPENDENT
RELATIONSHIP
ZIP
COUNTRY
DEPENDENT
RELATIONSHIP
ZIP
MIDDLE NAME
CITY
COUNTRY
RELATIONSHIP
MIDDLE NAME
CITY
DEPENDENT
RELATIONSHIP
MIDDLE NAME
CITY
ADDRESS
ZIP
MIDDLE NAME
CITY
ADDRESS
STATE
COUNTRY
RELATIONSHIP
MIDDLE NAME
CITY
ADDRESS
ZIP
MIDDLE NAME
CITY
ADDRESS
STATE
RELATIONSHIP
MIDDLE NAME
CITY
ADDRESS
LAST NAME
MIDDLE NAME
COUNTRY
DEPENDENT
RELATIONSHIP
ZIP
COUNTRY
DEPENDENT
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
DATE OF BIRTH
CUSTODY
SELFCARE
Ppeeki Qienpb Ackfmkbd - 320-88-8792
The applicant has been shown the following films:
Aptitude Index Film
BMTS Film
CCT/PJ Film
COT Film
MEPS Processing
Film
OTS/COT Film
Security Forces Film
EOD Film
Peace Keepers Film
ALTERNATE EMAILS
Type
ALTERNATE PHONES
Email
Type
Email
Ppeeki Qienpb Ackfmkbd - 320-88-8792
Have you ever been a party to any public record civil court actions?
No
Civil Court
Date Initiated
Organization Handling Case
Nature of Action
Names of Parties Involved
Finance
Type
Amount
Date Initiated
Account Number
Name Action Occurred Under
Type
Amount
Date Initiated
Account Number
Name Action Occurred Under
Type
Amount
Date Initiated
Type
Date Initiated
Type
First
Date Initiated
Account Number
Name Action Occurred Under
Type
Amount
First
Account Number
Name Action Occurred Under
Amount
First
Account Number
Name Action Occurred Under
Amount
First
First
Date Initiated
Account Number
Name Action Occurred Under
First
Date Satisfied
Bankruptcy Type
Organization
Status
Last
Date Satisfied
Bankruptcy Type
Bankruptcy Type
Bankruptcy Type
Bankruptcy Type
Bankruptcy Type
Last
Middle
Suffix
Middle
Suffix
Middle
Suffix
Middle
Suffix
Status
Organization
Status
Organization
Status
Last
Date Satisfied
Suffix
Organization
Last
Date Satisfied
Middle
Status
Last
Date Satisfied
Suffix
Organization
Last
Date Satisfied
Middle
Organization
Status
Ppeeki Qienpb Ackfmkbd - 320-88-8792
EDUCATION
Grade Relevance
Accredited From
Name of School
West Valley High School(Rcj)
Major Code Major
School Type
Degree Title
Grade Relevance
School Type
9711 Ukndc Svpi
Accredited From
Degree Type
Accredited From
Major Code Major
School Type
Grade Relevance
Degree Type
Accredited From
Major Code Major
School Type
Degree Type
Highest Education Year Completed
Education Level
State
D
Zip
City
To
State
Zip
Tier
Country
Tier
Country
No. Yrs Comp Graduated Qual Degree
Apt
Address
City
State
Zip
L
MEPCOM
Education Level
Medical Specialty
Y
Country
Total College Quarter Hours
What paramilitary organizations (JROTC/CAP/Scouts) has the lead participated with? P - Didn't participate in JROTC or CAP program.
Degree/Residency
Country
Us
No. Yrs Comp Graduated Qual Degree
Total College Semester Hours
12
99709
Tier
Total Quality Points Total Credit Hours Total Semester Hrs
Other Major
Degree Title
Zip
No. Yrs Comp Graduated Qual Degree
City
To
Apt
Address
Name of School
State
Ak
Total Quality Points Total Credit Hours Total Semester Hrs
Other Major
Degree Title
City
Fairbanks
To
Apt
Address
Name of School
Yes
Total Quality Points Total Credit Hours Total Semester Hrs
Other Major
Degree Title
Grade Relevance
Apt
Address
High School Diploma
Name of School
Tier
Total Quality Points Total Credit Hours Total Semester Hrs
Degree Type
Major Code Major
No. Yrs Comp Graduated Qual Degree
20070801 20110501
Other Major
Secondary or High School
To
Award Type
N
Civil Air Patrol
Yr Awarded
Scout Award
Yr Awarded
JROTC
ROTC
MEDICAL OFFICER CREDENTIALS
Licensed
Certified
Registered
Board Certified
Ppeeki Qienpb Ackfmkbd - 320-88-8792
AFOQT
Form/Version
Date Tested
Pilot
Nav
AA
Verbal
Quantitative
Other Tests
Type
Date
Version
Score
ASVAB
Test
Date
Version
QT
M
A
G
E
Test Location
GS AR WK PC MK
EI
AS MC AO
VE
NO CS
Validation
Date
Other Tests
Date
Specialty
Pull-Ups
Count
Push-Ups
Count
Date
Count
Push-Ups
Count
Pull-Ups
Count
Count
Count
Push-Ups
Count
Overall
Surface Swim
Run
Type
Sit-Ups
Count
Underwater Swim 1
Underwater Swim 2
Sit-Ups
Count
Underwater Swim 1
Underwater Swim 2
Run
Count
Underwater Swim 1
Underwater Swim 2
Sec
Min
Sec
Min
Sec
Min
Sec
Overall
Surface Swim
Run
Type
Sit-Ups
Min
Overall
Surface Swim
Type
Specialty
Pull-Ups
Underwater Swim 1
Underwater Swim 2
Specialty
Push-Ups
Date
Count
Specialty
Pull-Ups
Date
Type
Sit-Ups
Min
Sec
Min
Sec
Overall
Surface Swim
Run
Min
Sec
Min
Sec
Ppeeki Qienpb Ackfmkbd - 320-88-8792
Accessions Interview
What AFSC is the applicant enlisting / training into? (DAFSC)
Is this a Critical AFSC?
Is member fully qualified for the AFSC?
What PAS Code / Unit will the applicant be accessing into?
What Position number will the applicant be placed into?
Enter Date of Appointment
Enter Date of Enlistment
Enter Enlistment Pay Grade
Did applicant attend the Air Force Academy?
Ppeeki Qienpb Ackfmkbd - 320-88-8792
Physical Data
Source (TOSIP, DD FORM 2807-1)
Physical Date
Physical Type
Physical Location
Physical Height
P
U
Specify if Other
Specify if Other
Location Type
Physical Weight
L
H
E
S
X
BFM%
Uncorrected distant vision for left eye 20/
right eye 20/
Corrected distant vision for left eye 20/
right eye 20/
Uncorrected near vision for left eye 20/
right eye 20/
Corrected near vision for left eye 20/
right eye 20/
Is vision corrected with glasses, or contacts?
Color Vision Passed?
Does the applicant have unrestricted use of all fingers on both hands?
Does the applicant have a speech impediment?
Depth Perception Passed?
Explain
Drug Use
Does the applicant have a fear of heights?
Explain
Source (TOSIP, DD FORM 2807-1)
Physical Date
Physical Type
Physical Location
Physical Height
P
U
Specify if Other
Specify if Other
Location Type
Physical Weight
L
H
E
S
X
BFM%
Uncorrected distant vision for left eye 20/
right eye 20/
Corrected distant vision for left eye 20/
right eye 20/
Uncorrected near vision for left eye 20/
right eye 20/
Corrected near vision for left eye 20/
right eye 20/
Is vision corrected with glasses, or contacts?
Color Vision Passed?
Does the applicant have unrestricted use of all fingers on both hands?
Does the applicant have a speech impediment?
Depth Perception Passed?
Explain
Drug Use
Does the applicant have a fear of heights?
Explain
Source (TOSIP, DD FORM 2807-1)
Physical Date
Physical Type
Physical Location
Physical Height
P
U
Specify if Other
Specify if Other
Location Type
Physical Weight
L
H
E
S
X
BFM%
Uncorrected distant vision for left eye 20/
right eye 20/
Corrected distant vision for left eye 20/
right eye 20/
Uncorrected near vision for left eye 20/
right eye 20/
Corrected near vision for left eye 20/
right eye 20/
Is vision corrected with glasses, or contacts?
Color Vision Passed?
Does the applicant have unrestricted use of all fingers on both hands?
Does the applicant have a speech impediment?
Depth Perception Passed?
Explain
Drug Use
Does the applicant have a fear of heights?
Explain
Source (TOSIP, DD FORM 2807-1)
Physical Date
Physical Type
Physical Location
Physical Height
P
U
Specify if Other
Specify if Other
Location Type
Physical Weight
L
H
E
S
X
BFM%
Uncorrected distant vision for left eye 20/
right eye 20/
Corrected distant vision for left eye 20/
right eye 20/
Uncorrected near vision for left eye 20/
right eye 20/
Corrected near vision for left eye 20/
right eye 20/
Is vision corrected with glasses, or contacts?
Color Vision Passed?
Does the applicant have unrestricted use of all fingers on both hands?
Does the applicant have a speech impediment?
Depth Perception Passed?
Explain
Drug Use
Does the applicant have a fear of heights?
Explain
Source (TOSIP, DD FORM 2807-1)
Physical Date
Physical Type
Physical Location
Physical Height
P
U
Specify if Other
Specify if Other
Location Type
Physical Weight
L
H
E
S
X
BFM%
Uncorrected distant vision for left eye 20/
right eye 20/
Corrected distant vision for left eye 20/
right eye 20/
Uncorrected near vision for left eye 20/
right eye 20/
Corrected near vision for left eye 20/
right eye 20/
Is vision corrected with glasses, or contacts?
Color Vision Passed?
Does the applicant have unrestricted use of all fingers on both hands?
Does the applicant have a speech impediment?
Depth Perception Passed?
Explain
Does the applicant have a fear of heights?
Drug Use
Explain
Ppeeki Qienpb Ackfmkbd - 320-88-8792
MAIDEN NAME / ALIAS NAMES
Enter maiden name and alias names used. Mark checkbox if maiden name. Include from and to dates.
Maiden
First Name
Middle Name Last Name
Suffix
From Date To Date
Reason
Other
Maiden
First Name
Middle Name Last Name
Suffix
From Date To Date
Reason
Other
Maiden
First Name
Middle Name Last Name
Suffix
From Date To Date
Reason
Other
Maiden
First Name
Middle Name Last Name
Suffix
From Date To Date
Reason
Other
Ppeeki Qienpb Ackfmkbd - 320-88-8792
Recruiter
Rpbnktd, Etnbc J - AK168ROWZ8
COURSES
Algebra
Geometry
Physics
Trigonometry
Biology
Chemistry
Typing
English Composition
Computer
English
Mathematics
General Science
OTHER JOB QUALIFIERS
SJC Code
Does the applicant have a fear of insects or Spiders?
Does the applicant have a fear of blood?
Does the applicant have a fear of guns?
Does the applicant have a fear of fire?
Does the applicant have a history of emotional instability?
Does the applicant have a history of conviction for embezzlement?
Does the applicant have a history of confinement?
Does the applicant have a history of claustrophobia?
Does the applicant speak distinct English?
Have you ever been in the Peace Corps?
Does the applicant have a history of Temporomanibular Joint Disorder
(TMJ), jaw locking or jaw pain?
Have you ever been convicted of a crime of domestic violence?
F
| File Type | application/pdf |
| File Modified | 2014-01-31 |
| File Created | 2014-01-31 |