Nsctng 025 - Escort Officer Questionnaire Form
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1ESCORT OFFICER
U.S. NAVAL SEA CADET CORPS
U.S. NAVY LEAGUE CADET CORPS
QUESTIONNAIRE
INSTRUCTIONS
1.
This form must be used to screen Escort Officers for service at NSCC/NLCC training contingents.
2.
Include the completed form when submitting NSCTNG 002 or NSCTNG 004 to COTC for service as an Escort Officer.
3.
The COTC will review each item on this form when evaluating suitability for service and billet assignments at NSCC/NLCC training.
Refer to the current training schedule for any additional training requirements.
4.
1. PERSONNEL INFORMATION
1a. Last Name
1b. First Name
1c. Social Security Number
1d. Rank
1e. Age
1f. Address
1g. City
1h. State
1i. Zip Code +4
1j. Primary Phone Number
1k. Alternate Phone Number
1l. E-mail Address
1m. Unit Name
1n. Unit Location
1o. Gender
Male
Female
2. EXPERIENCE (Use additional sheets if necessary)
2a. Home Unit Primary Billet
2b. Home Unit Collateral Billet(s)
2c. Have you ever been a COTC?
Yes
No
If yes, where and when:
2d. Have you ever been an Escort Officer?
Yes
No
If yes, where and when:
2e. Are you former, retired or present military?
Yes
No
If yes, list branch and highest rank/rate attained:
2f. Have you ever attended formal leadership training or NSCC Officer Professional Development courses?
Yes
No
If yes, list courses completed and dates:
2g. Do you have formal medical training?
Yes
No
If yes, list qualification and attach documentation:
3. BILLET ASSIGNMENT
3a. Billet Preference(s)
3b. Is there any billet assignment that you would not want, or could not perform?
Yes
No
If yes, explain:
3c. Is there any reason you could not be assigned as a recruit division commander or division officer?
Yes
No
If yes, explain:
3d. Do you have any current physical restrictions?
Yes
No
If yes, explain:
3e. Do you have a valid state driver’s license?
3f. Do you have a valid bus driver’s license?
Yes
No
If yes, State of Issue:
Yes
No
If yes, State of Issue:
4. TRAVEL INFORMATION
4a. Mode of travel
4b. Name of Airline/Train/Bus (if applicable)
4c. Arrival Flight Number
4d. Departure Flight Number
Airline
Train
Bus
Car
4e. Date of Arrival (DD MMM YY)
4f. Time of Arrival (Military time)
4g. Date of Departure (DD MMM YY)
4h. Time of Departure (Military time)
4i. Make of Motor Vehicle
4j. Model
4k. Color
4l. License Plate Number and State
TRAVEL IN APPROPRIATE NSCC OR MILITARY UNIFORM IS RECOMMENDED FOR EASY IDENTIFICATION
5. COMMENTS
NSCTNG 025 (REV 04/14)
PREVIOUS EDITIONS MAY BE USED
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