Prescribed by: COMNAVCRUITCOMINST 1130.8
CONTROLLED
when filled in
when filled in
WAIVER BRIEFING SHEET
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 133, 275, 503, 504, 508, 510, 672, 1071-1087, 1168, 1169, 1475-1480, 1553, 5013; and E.O. 9397 (SSN).
PRINCIPAL PURPOSES: To provide recruiters with information concerning personal history, education, professional qualifications, mental aptitude, and other individualized items which may influence the decision to select or non-select an individual for enlistment or commission in the U.S. Navy.
DISCLOSURE: Disclosure is voluntary; however, failure to provide the requested information may prevent enlistment in the U.S. Navy.
| NAVTALACQGRU | NAVCRUITSTA | RECRUITER |
| NAME: (LAST NAME, FIRST NAME, MIDDLE NAME) | AGE |
| TYPE OF WAIVERS REQUIRED |
| ELIGIBLE FOR: |
MHS GENESIS MEDICAL DATA
HEIGHT: WEIGHT:
MAX WEIGHT:
BODY FAT:
HIV OR DAT RESULTS DOCUMENTED:
SINGLE SITE:
|
| MARITAL STATUS | NO. DEPENDENTS | EDUCATION CODE | AFQT SCORE | LEGAL DETERMINATION NO. |
| EMPLOYMENT HISTORY (LAST FIVE YEARS) | ||||
| FROM (YYMM) | TO (YYMM) | EMPLOYER OR COMPANY (MOST RECENT FIRST) | POSITION | REASON FOR LEAVING |
|---|---|---|---|---|
| PRIOR SERVICE RECORD | ||||
| FROM (YYMM) | TO (YYMM) | BRANCH (ACTIVE OR RESERVE) (MOST RECENT FIRST) | RE-CODE | PAYGRADE |
|---|---|---|---|---|
Prescribed by: COMNAVCRUITCOMINST 1130.8
| NAME: (LAST NAME, FIRST NAME, MIDDLE NAME) |
| DEP HISTORY | |||
| FROM (YYMM) | TO (YYMM) | BRANCH (MOST RECENT FIRST) | REASON FOR DEP DISCHARGE |
|---|---|---|---|
| FINANCIAL/DEBT | |||
| HAS APPLICANT EVER FILED FOR BANKRUPTCY? | IF YES, DATE | ||
| HAS APPLICANT EVER BEEN MORE THAN 60 DAYS LATE ON ANY PAYMENT? | |||
| DOES APPLICANT HAVE ANY LIENS OR JUDGEMENTS PENDING? | |||
| STATEMENT REGARDING DEBT (REQUIRED FOR ANY "YES" RESPONSE ABOVE): | |||
| CIVIL OR CRIMINAL OFFENSES | ||||
| DATE (YYMM) | ORIGINAL CHARGE (MOST RECENT FIRST) | ADJUDICATED CHARGE | OFFENSE CODE | DISPOSITION |
|---|---|---|---|---|
| DRUG USE | |
| DRUG TYPE, TIMES USED, DATE OF LAST USE | DRUG TYPE, TIMES USED, DATE OF LAST USE |
|---|---|
Prescribed by: COMNAVCRUITCOMINST 1130.8
| NAME: (LAST NAME, FIRST NAME, MIDDLE NAME) |
| SUPPLEMENTAL COMMENTS AND RECOMMENDATIONS: |
| WAIVER CODING | ||||||||
| WAIVER CODES FOR DD FORM 1966 | ||||||||
| WAIVER CODES FOR PRIDE | ||||||||
| CIVIL OFFENSE CODE FOR PRIDE | ||||||||
The Commanding Officer is responsible for ensuring proper waiver and offense codes are documented and recorded in PRIDE and DD FORM 1966. Waiver authority is responsible for verifying the appropriate waiver and offense codes to be used when making waiver determination.
| WAIVER APPROVAL AUTHORITY | |
| NAVTALACQGRU COMMANDING OFFICER'S DETERMINATION | |
|
Signature and Date
| |
| NAVCRUITREG DETERMINATION ICO MAJOR MISCONDUCT WAIVER | |
|
Signature and Date
| |
| NAVCRUITCOM DETERMINATION | |
|
Signature and Date
|