Marine Corps Screening Form
Congratulations, you've made the first step. Tell us more about yourself to see if you're qualified, and a member from our team will get in touch with you.
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
Current City, State
*
ex. Portland, OR
Please select your Gender
*
Female
Male
Are you a High School graduate with a standard diploma?
*
Yes
No
Are you currently attending college?
Yes
No
If Yes, what school
ex. Portland Community College, University of Oregon
Select your Birth Date
*
-
Month
-
Day
Year
Date
Place of Birth
*
Ex. Milton-Freewater, Oregon
Height
*
ex. 5'7 or 67 inches
Weight
*
ex. 185
Last Time of Marijuana Usage
*
None
1-30 Days
30-90 Days
90-180 Days
180+ Days
Any other drug usage?
Yes
No
If yes, what type and last usage?
Police Involvement to include tickets or juvenile record
*
Yes
No
If yes, explain (open or closed)
Medical History (Current of past history of)
*
Surgeries / Operations
Self-Harm
Vision/Glasses
Implants (pins, plates)
Broken Bones
Asthma/Inhaler Usage
Medication Usage (ADHD, Depression, Anxiety)
ER Visits
Skin (ex. Eczema)
Counseling
Other
If you answered yes to any of the above questions, please explain below:
*
List any extracurricular activities you are involved in.
ex. Sports, volunteer work, hobbies
Which best represents your current level of physical fitness?
My physical fitness needs some improvement
I work out sometimes (less than 3 days per week)
I work out often (3-5 days per week)
I am very physically fit
I am a physical fitness master
What would interest you about the Marine Corps? (Select all that apply)
Challenge
Self-Direction, Self- Discipline, and Self Reliance
Leadership and Management Skills
Financial Security and Benefits
Technical Skills
Professional Development
Education Benefits
Travel and Adventure
Physical Fitness
Pride of Belonging
Courage, Poise, Self-Confidence
Patriotism
Submit
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