SECTION I / PERSONAL INFORMATION
NAME: (Last, First MI) / Rank / DOR
Time-in-Service / DOS / HYT Date / Promotion Line No. (if applicable)
AFSC & Title / Previous AFSC & Title
Current Unit of Assignment / DAS / TOS (months) / CONUS Controlled Tour
Yes No / DSN
Duty Title / Duty Address / Military Email
Current Overseas Tour Length
Short Long Ext Long / DEROS (mmm-yy) / Overseas Return Date (mmm-yy) / Contacted Functional Mgr Yes No
Is Early Release Possible? Yes No Unk
SECTION II / EDUCATION
AFSNCOA Class Designation / Flight Number / Graduation Date (dd-mmm-yy) / Instructor’s Rank & Last Name
NCOA Grad Date / PME Awards (check all that apply)
Levitow Commandant DG Other: ______
Previous PME Assignment
Yes No / PME Assignment Dates (mmm-yy)
From: To: / PME Duty Title
Highest Degree Awarded
Associate Bachelors Masters PHD / Name of College / Major of Highest Degree Awarded
SECTION III / INTERVIEW QUESTIONS
Briefly answer the following questions…
Why do you want to join the AFSNCOA team?
Why do you feel you would make a good PME Instructor?
Although teaching experience is NOT a requirement, please describe any teaching/instructor experience you do have.
How many people do you currently supervise or have previously supervised?
What do you think of the curriculum here at the AFSNCOA?
What deployments have you been on?
What is your current fitness level?
What are your long-term Air Force and personal goals?
Signature / Date
Maxwell AFB Form 120, 19951101 (AFSNCOA/ED) Replaces AU Form 1021, Oct 91, which is obsolete
SECTION IV / FLIGHT INSTRUCTOR COMMENTS AND RECOMMENDATIONCheckonly one rating per category and provideappropriate comments to support your rating.
Ability to Write / Poor / Fair / Good / Excellent / Outstanding
Ability to Speak / Poor / Fair / Good / Excellent / Outstanding
Overall Attitude Toward Curriculum / Poor / Fair / Good / Excellent / Outstanding
Overall Academic Performance / Poor / Fair / Good / Excellent / Outstanding
Judgment / Poor / Fair / Good / Excellent / Outstanding
Decisiveness / Poor / Fair / Good / Excellent / Outstanding
Effectiveness in leading / Poor / Fair / Good / Excellent / Outstanding
Acceptance of Responsibility / Poor / Fair / Good / Excellent / Outstanding
Overall Bearing and Behavior / Poor / Fair / Good / Excellent / Outstanding
Would you want this individual on your team? Briefly explain your answer…
Recommendation Do Not Hire Hire:
Average (rating scale) Awesome
Printed Rank/Name (Last, First, MI) / Signature / Date (dd-mmm-yy)
SECTION V / DIVISION CHIEF’S RECOMMENDATION
Comments:
Recommendation Do Not Hire Hire:
Average (rating scale) Awesome
Printed Rank/Name (Last, First, MI) / Signature / Date (dd-mmm-yy)
Maxwell AFB Form 120, 19951101 (Reverse)