Instructor Reference 2300, 2300



ACTIVE/RESERVE MEDICAL SERVICE CORPS (MSC) OFFICER APPLICATION CHECKLISTMSC Direct 2300 / MSC Recall 23001 / MSC HSCP 23007 / MSC HPSP 1995 / Reserve 2305ATTENTION All NAVCRUITDISTs: Documents should be attached in CIRIMS per the CIRIMS User Guide.NAME: FORMTEXT ?????DESIGNATOR: FORMTEXT ????? NAVCRUITDIST PROC: FORMTEXT ?????NAVCRUITDIST: FORMTEXT ?????OQPI YES N/ASECTION 1: PROGRAM DOCUMENTS001 FORMCHECKBOX Scroll Pre-Screening Form (NC 1131/67) submitted to NAVCRUITCOM via OPO 106 FORMCHECKBOX FORMCHECKBOX Personal and Professional Information Sheet required for 2300, 2305, 23001 only. Podiatrist, Optometrist, Audiologist, Physician Assistant, Clinical Psychologist, Pharmacist, Dietician, Social Worker, Physical Therapist, Occupational Therapist (Note 106)107 FORMCHECKBOX FORMCHECKBOX Submit to Centralized Credentials and Privileging Department, Jacksonville, FL (CCPD-JAX) All specialties that are health care providers and hold a state license(s). (CCPD-JAX checklist available on N34 website) (Podiatrist, Optometrist, Audiologist, Physician Assistant, Clinical Psychologist, Pharmacist, Dietician, Social Worker, Physical Therapist, Occupational Therapist) (Note 107)SECTION 2: BASIC APPLICATION023 FORMCHECKBOX Application Checklist 002 FORMCHECKBOX Application Processing and Summary Record (NC 1131/238)015 FORMCHECKBOX EPSQ (SF 86) signed and dated by applicant within past 6 months (Refer to COMNAVCRUITCOM NOTE 5510). Submit to OPM at time of Physical. (Note 015)004 FORMCHECKBOX FORMCHECKBOX Birth Certificate or FORMCHECKBOX Request Verification of Birth (DD Form 372) if original birth certificate unavailable 006 FORMCHECKBOX FORMCHECKBOX Evidence of Citizenship Form (NC 1100/25) if naturalized008 FORMCHECKBOX Social Security Card Issued by Social Security Administration (SSA) or DD Form 214 or Report of Separation and Record of Service for Prior Army or Air National Guard Members (NGB Form 22) (Note 008)SECTION 3: PERSONAL INFORMATION018 FORMCHECKBOX Resume / Curriculum Vitae signed and dated by applicant103 FORMCHECKBOX Professional Community Interviewer’s Appraisal Sheet (NC 1131/5) (Note 103)019 FORMCHECKBOX FORMCHECKBOX Employment References DD Form 370, front and back pages. Minimum of three references are required. Submit DD 370 from each employer for the last three years. Character reference(s) required when employer references are not available. The Commanding Officer shall be requested to provide a DD 370 for all applicants who are serving on active or inactive duty in all branches. 020 FORMCHECKBOX FORMCHECKBOX Character References required if employment references are not available. (only upon PM approval and notation on Form DD370) 117 FORMCHECKBOX FORMCHECKBOX Instructor Reference 2300, 23007 and 2305 include if applying for student programs and if employment references are not applicable. College Committee letters accepted.104 FORMCHECKBOX FORMCHECKBOX Licensure Verification for Medical Program Applicants (NAVPERS 1300/4) and Copy of Current License for all states ever licensed for all clinical specialties requiring licensing ( Podiatrist, Optometrist, Audiologist, Physician Assistant, Clinical Psychologist, Pharmacist, Dietician, Social Worker, Physical Therapist, Occupational Therapist)121 FORMCHECKBOX FORMCHECKBOX Duty Preference for Medical Programs (NC 1131/16) all DIRECT programs, three choices required. Ensure applicant and recruiter contact information is accurate and current.125 FORMCHECKBOX FORMCHECKBOX Application Letter for Medical Service Corps Accession Bonus if applicable (A declination letter is required if the applicant does not want the authorized bonus)126 FORMCHECKBOX FORMCHECKBOX Application for HPLRP if eligible (A declination letter is required if the applicant does not want the LRP)SECTION 4: PRIOR SERVICE INFORMATION009 FORMCHECKBOX FORMCHECKBOX DD 214(s) If prior active service/reserve service (note member’s copy page 4)012 FORMCHECKBOX FORMCHECKBOX Conditional Release (DD 368) Navy Drilling Reserve, IRR and all non-Navy military024 FORMCHECKBOX FORMCHECKBOX CO’s Recommendation all Active Duty applicants123 FORMCHECKBOX FORMCHECKBOX Enlisted Personnel Action Request (NP 1306/7) active duty Navy enlisted only. (Note 123)013 FORMCHECKBOX FORMCHECKBOX Contingent Resignation Letter if prior or currently commissioned (approval letter required to final selection)011 FORMCHECKBOX FORMCHECKBOX Statement of Service for prior Commissioned Officers010 FORMCHECKBOX FORMCHECKBOX Prior Service Record If prior service; send only fitreps/evals, pgs 4, 5, 9, and any derogatory information (Note 010)SECTION 5: MISCELLANEOUS DOCUMENTS005 FORMCHECKBOX FORMCHECKBOX Change of Name Statement (NC 1131/14) and provide copy of court documents/marriage license 021 FORMCHECKBOX FORMCHECKBOX Family Care Plan Certificate (NP 1740/6) must include if single parent or dual military as applicable016 FORMCHECKBOX FORMCHECKBOX Police Record Checks (DD 369) Submit if any derogatory information noted on application105 FORMCHECKBOX FORMCHECKBOX Maximum Age Statement of Understanding (NC 1131/54) 022 FORMCHECKBOX United States Navy Tattoo Screening Certificate (NC 1130/104) 026 FORMCHECKBOX Tattoo/Body Art/Mutilation/Body Marking Warning (NAVPERS 1070/613)007 FORMCHECKBOX Disclosure of SSN Privacy Act Statement (NC 5211/1)014 FORMCHECKBOX Statement of Understanding for Security Investigation (NC 1070/613)017 FORMCHECKBOX Fingerprint Charts (FD258) Retain at NRD. 180 FORMCHECKBOX Commitment To Success Statement of Understanding (NC 1131/15) SECTION 6: ACADEMIC INFORMATION003 FORMCHECKBOX Copies of Official Transcripts include all front and reverse sides for each college attended (Note 003)101 FORMCHECKBOX FORMCHECKBOX Academic Degree Completion Plan (NC 1131/4) Include for HSCP, HPSP, and DIRECTs (within 6 months prior to graduation). Ensure total hours blocks and required hours blocks completed, applicant is enrolled full time Spring and Fall if applying for HSCP/HPSP and signed by Dean/advisor. 2300, 2305 submitting kits anticipating graduation.113 FORMCHECKBOX FORMCHECKBOX Academic Year Statement 1995 PA. Not required for kit submission but required before FINSEL. NRD must submit to NMPT&E with signed Commissioning Documents (Oath of Office & Service Agreement) FORMCHECKBOX FORMCHECKBOX GPA Calculation Worksheet (NC 1131/53) include all schools attended for student programs. Only qualifying degree required for Direct Accession (DA) and Direct Commission Officers (DCO) who have already graduated. Not required for DA or DCO with at least three years experience in respective subspecialty.114 FORMCHECKBOX FORMCHECKBOX Professional School/Residency Entrance Exam Report (OAT scores for Optometry HPSP 1995) 115 FORMCHECKBOX FORMCHECKBOX Letter of Acceptance to School/Residency all HSCP and HPSP students not yet attending school/residency. 116 FORMCHECKBOX FORMCHECKBOX Letter of Good Standing with School/ Residency Include for HSCP and HPSP if currently enrolled and if applying for DIRECT within 6 months prior to graduation. Letter must include projected graduation date. Not required for Clinical Psychology Internship applicants. (LOGS will be acceptable in place of a LOA for someone already in school/residency)128 FORMCHECKBOX FORMCHECKBOX GRE or GMAT Score. HSCP for HCA require GRE score of (1050 old GRE version or 303 new GRE version) or a GMAT score of 525 to apply.SECTION 7: RECALL (Note: Not eligible if FOS x2)108 FORMCHECKBOX FORMCHECKBOX Application for Recall to Ext Active Duty (NP 1331/5) prior commission any service (note fail to selects)110 FORMCHECKBOX FORMCHECKBOX PRIMS Report111 FORMCHECKBOX FORMCHECKBOX Annual Statement of Service History (ASOSH) - Point Capture112 FORMCHECKBOX FORMCHECKBOX Last 4 FITREPs (dependent upon length of service)SECTION 9: WAIVERS900 FORMCHECKBOX FORMCHECKBOX All required NRC Mandatory Determinations completed and attached.910 FORMCHECKBOX FORMCHECKBOX All required CO NRD Alcohol/Drug/Civil Waivers approved and attached.920 FORMCHECKBOX FORMCHECKBOX All required NRC Alcohol/Drug/Civil Waivers approved and attached.930 FORMCHECKBOX FORMCHECKBOX Required RE-code waiver approved and attached. FORMTEXT ?????Printed Name of Person CompletingSignature/Date of Person CompletingR-OPS/AR-OPS Signature/DateChecklistChecklistNotes:003Transcripts can be electronic version but must be printed in the Recruiter’s presence and signed/dated by an Officer Recruiter (in rank of 01 or above) to be a true copy. If classes taken at a prior school are listed with class name and grade on degree transcript applicant does not need to request that transcript. Cannot just state number or credits/hours transferred. Transcripts obtained online must be official transcripts.008Copies should be "Certified as a True Copy" to ensure that the original was cited and "Reproduced for Reference Purposes Only" written or typed in a conspicuous location.010Any derogatory information requires a clarifying statement on the Application Processing & Summary Record (APSR).015If applicant has a current NACLC (<10 yrs old) or SSBI (<5 yrs old) in JPAS, with no break in service >2 yrs, a new SF-86 must be completed. Include a copy of the new SF-86 and JCAVS Personal Summary Page with the completed application. Note: The SF-86 will not be transmitted to OPM in NASIS unless requested from higher authority. If applicant had a >2 year break in federal service since adjudication of their NACLC or SSBI, a new SF-86 must be submitted to OPM via EQIP.103At least one (1) interview must be by an active duty officer in same subspecialty for which applying; second interview may be from any Naval officer (active, reserve or retired). Interviews cannot be from anyone in recruiting and at least one must be in person. Required O-4 or above interviewer unless otherwise negotiated with Specialty Leader/Program Manager. Annotate on NC1131/1 if negotiation made with SL/PM. Note: Clinical Psychology Intern and USUHS: Recruiters must schedule interviews directly with Naval Medical Center San Diego & National Naval Medical Center Bethesda Training Directors. Annotate on NC 1131/1 the date of proposed interviews if unable to complete prior to kit submission. Recommend applicant obtain phone interview with Training Director from other MTF that they are not interviewing in person. This is not required but suggested.106The two peer references in the CCPD credentialing package counts as two of the three references required for the kitsubmission. A copy of these must be placed within the application with the other references.107Pending graduates do not need CCPD; however, new graduates need CCPD.123Active duty applicants applying for program must submit an NP1306, including message release from NPC (requesting conditional release). Once applicant is final selected, NRD must submit an NP1306 requesting discharge or release from active duty. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download