TITLE 10 AGR - Ohio Air National Guard



TITLE 10 AGR OFFICER APPLICATION CHECKLISTRANK ______ LAST NAME ____________ FIRST NAME ____________ MI________SSN _____________ DOR __________ BR_____ STATE ____ MRD _________CURRENT STATUS(circle one): M-Day T-32 ADSW T-10 ADSW Mil Tech TTAD AC USAR COTTAD Other ______DAYTIME PHONE: ______________________ E-MAIL: _______________________PACKET SEQUENCE: Incomplete packets will be returnedTabRequirement1______ NGB Form 34-1 (GKO)(1)______ AGR Tour Agreement (GKO)(2)______ One Time Occasional Tour Agreement (if applicable) (3)______ Tour Assignment Preference Statement (GKO)2______ ORB - Certified Copy and signed by applicant 3______ DA Photo (within last 12 months)4______ DA FORMs 67-9: Last three years consecutive OERs (Profiled) and/or AERs (Must include all profiled Command OERs if not already included)5______ DA FORM 705: Last two consecutive APFT scores, most recent within 12 months.(1) ______ DA Form 5500/1-R, Body Fat Content Worksheet (if applicable)(2) ______ DA Form 3349, Physical Profile (if applicable)6______ Individual Medical Readiness (IMR) Record (Physical Exam and/or AMC/PHA within 1 year & HIV within 2 years)7______ NGB Form 23b8 ______ DD Form 1172 (signed by certified official)9______ Security Clearance Verification (Memorandum verified by Security Manager)10______ Proof of highest military education completed11 ______ Civilian education; all transcripts (photocopies accepted) Date Rec’d _______________ Date Inventoried: _______________ Date given to AO: _______________ ................
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