PO-SOD DATA SHEET

SECTION I
STATEMENT OF PERSONAL HISTORY
DATA REQUIRED BY THE PRIVACY ACT
AUTHORITY:EXECUTIVE ORDER 9397, 10450, 11652.
PRINCIPAL PURPOSE:TO RECORD DATA CONCERNING INDIVIDUALS WHO VOLUNTEER FOR ASSIGNMENT TO SPECIAL MISSIONS.
USES:TO ASSIST IN SCREENING OF APPLICANT.
MANDATORY/VOLUNTARY ALL INFORMATION IS VOLUNTARY
DISCLOSURE AND EFFECTAND REFUSAL TO PROVIDE IT WILL
ON INDIVIDUAL NOT PREVENT FAVORABLE CONSIDERATION
PROVIDING INFORMATION:OF VOLUNTEER’S REQUEST FOR ASSIGNMENT.

DO YOU MEET THE MINIMUM PREREQUISTES BELOW?

MINIMUM PREREQUISITES
1. VOLUNTEER
2. GT 110 OR HIGHER
3. MUST BE QUALIFIED IN CURRENT MOS
4. GRADE: MINIMUM E-5
5. TIME IN SVC: MINIMUM 4 YRS
6. PHYSICAL PROFILE: NO PROFILES OR DUTY LIMITATIONS (CAN WEAR
GLASSSES)
7. US CITIZEN / 8. AGE: MINIMUM 22 YRS
9. AIRBORNE QUALIFIED OR VOLUNTEER
10. 1st CLASS PFT SCORE
11. RETENTION: SRR OF 2 YRS
12. UCMJ / FINANCIAL: NO RECURRING PATTERNS
13. SECURITY CLEARANCE: SECRET ELIGIBLE / UPGRADE TO TOP SECRET
YES / NO
DATE / RANK / LNAME, FNAME, MI
SSN / MOS
CLEARANCE
TS – SCI / TS / S / UNK
INSTRUCTIONS: PRINT ALL ANSWERS. ENSURE ALL QUESTIONS ARE ANSWERED IN DETAIL. AN INCOMPLETE FORM CANNOT BE PROPERLY EVALUATED.
MILITARY INFORMATION
DUTY LOCATION / ADDRESS / COMM PHONE & CELL PHONE / DSN PHONE / FAX
EMAIL / TIME ON STATION
(PRESENT CMD) / DCTB
DD/MMM/YYYY / CURRENTLY IN RECIEPT OF ORDERS / REPORT DATE
YRS / MO / YES / NO
IF YES WHERE
DOR
DD/MMM/YYYY / PROMOTABLE / TIG / TIS / YEARS ACTIVE SERVICE
YES / NO / YRS / MO / YRS / MO / YRS / MO
PEBD
DD/MMM/YYYY / EAS
DD/MMM/YYYY / GT SCORE / BLOOD TYPE / CLOSEST AIRPORT
CURRENT PFT/CFT SCORE
MALE
DATE / PULLUP / SCORE / CRUNCHES / SCORE / 3-MILE RUN / SCORE / TOTAL / CLASS
DATE / MTC / SCORE / AMMOLIFT / SCORE / MAN U FIRE / SCORE / TOTAL / CLASS
FEMALE
DATE / FLEX AH / SCORE / CRUNCHES / SCORE / 3-MILE RUN / SCORE / TOTAL / CLASS
DATE / MTC / SCORE / AMMOLIFT / SCORE / MAN U FIRE / SCORE / TOTAL / CLASS
HIEGHT (IN INCHES) / WEIGHT / BODY FAT % (IF OVER HT/WT STANDARD)
PERSONAL INFORMATION
HOME ADDRESS / HOME PHONE / CELL PHONE / EMAIL
DOB
DD/MMM/YYYY / AGE
DD/MMM/YYYY / PLACE OF BIRTH / CITIZENSHIP
NATIVE BORN / NATURALIZATION #
MARITAL STATUS
SINGLE / MARRIED / LEGALLY SEPARATED / # OF TIMES MARRIED / # OF TIME DIVORCED
YES / NO / YES / NO
YES / NO
YRS / MO
IS YOUR SPOUSE IN THE MILITARY?
YES / NO / BRANCH OF SERVICE
ARE YOU ASSIGNED UNDER A JOINT DOMICILE?
YES / NO
NUMBER OF DEPENDENTS / LIST OF ALL DEPENDENTS
NAME / AGE / RELATIONSHIP
WHO HAS CUSTODY OF YOUR CHILDREN?
ARE YOUR DEPENDENTS CAPABLE OF CARING FOR THEIR OWN PERSONAL NEEDS IN YOUR ABSENCE?
ARE ANY OF YOUR DEPENDENTS ENROLLED IN THE EXCEPTIONAL FAMILY MEMBER PROGRAM OR SERIOUSLY ILL? IF YES, DESCRIBE.
LIST ALL TATOOS, LOCATION ON BODY, AND THEIR MEANING
LOCATION / MEANING
CIVILIAN EDUCATION (HS, COLLEGE, VO-TECHS, ON GOING STUDIES)
DATE / SCHOOL / LOCATION / QUALIFICATION
LISTSPECIALQUALIFICATIONSCHOOLS OR TRAINING
(AIRBORNE, DIVE, LANGUAGE ETC)
DATE / SCHOOL / LOCATION / QUALIFICATION
HAVE YOU EVER BEEN TERMINATED FROM JUMP OR DIVE STATUS?
IF YES, EXPLAIN WHEN AND WHY
DRIVER QUALIFICATION
MILITARY
DATE / TYPE VEHICLE / QUALIFICATION
HAVE YOU EVER HAD YOUR LICENSE REVOKED
IF YES, EXPLAIN WHEN AND WHY
EXPLAIN YOUR SPECIFIED, IMPLIED, AND ADDITIONAL RESPONSIBILITIES IN YOUR PRESENT ASSIGNMENT
LIST YOUR LAST FIVE MILITARY JOB DESCRIPTIONS
DATES / RANK / BILLET DISCRIPTION / DUTIES/RESPONSIBILITIES
LIST YOUR LAST FIVE MILITARY JOB DESCRIPTIONS
DATES / RANK / BILLET DISCRIPTION / DUTIES/RESPONSIBILITIES
LIST YOUR LAST FIVE MILITARY JOB DESCRIPTIONS
DATES / RANK / BILLET DISCRIPTION / DUTIES/RESPONSIBILITIES
LIST YOUR LAST FIVE MILITARY JOB DESCRIPTIONS
DATES / RANK / BILLET DISCRIPTION / DUTIES/RESPONSIBILITIES
LIST YOUR LAST FIVE MILITARY JOB DESCRIPTIONS
DATES / RANK / BILLET DISCRIPTION / DUTIES/RESPONSIBILITIES
LIST YOUR LAST FIVE MILITARY JOB DESCRIPTIONS
DATES / RANK / BILLET DISCRIPTION / DUTIES/RESPONSIBILITIES

SNCOIC RECOMMENDATION (Enlisted Candidates Only):

(Current Chain of Command approval to screen)

SNCOIC Contact info Name, rank, commercial, NIPR & SIPR address

OIC RECOMMENDATION (Officer and Enlisted Candidates):

(Current Chain of Command approval to screen)

OIC Contact info Name, rank, commercial, NIPR & SIPR address

SGTMAJ AND MGYSGT RECOMMENDATION/COMMENTS (ENLISTED ONLY UNIT LEVEL)

SGTMAJ:

______

SGTMAJ SIGNATURE AND DATE

MGYSGT:

______

MGYSGT SIGNATURE AND DATE

SGTMAJ AND MGYSGT Contact info Name, rank, commercial, NIPR & SIPR address

COMMANDING OFFICER RECOMMENDATION (unit level)

______

COMMANDING OFFICER SIGNATURE AND DATE

MARSOC FCM ENDORSEMENT (MARSOC ENLISTED ONLY, COMPONENT MGYSGT’S FOR RESPECTIVE MOS):

______

FCM SIGNATURE AND DATE

PO-SOD ENDORSEMENT (officer and enlisted)

______

PO-SOD SIGNATURE AND DATE

*** ONCE ALL ENDORSEMENTS ARE RECEIVED AND SNM IS DETERMINED TO BE ELIGIBLE FOR ASSIGNEMENT AND ASSOCIATED PCS. PO-SOD WILL ROUTE DATA SHEET D TO MMEA FOR FURTHER ACTION VIA TFRS. ***

DIRECT SPECIFIC QUESTIONS REGARDING COMPLETION OF THIS PACKAGE TO; COMMERCIAL (703) 571 1058/1059 OR DSN 651-1058/1059