DD Form 1966 Record of Military Processing - Armed Forces of the Unit

RECORD OF MILITARY PROCESSING - ARMED FORCES OF THE UNITED STATES

OMB No. 0704-0173
OMB approval expires
XX-XXX-XX

(Read Privacy Act Statement and Instructions on back before completing this form.)

The public reporting burden for this collection of information, 0704-0173, is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
A. SERVICE
C. SELECTIVE SERVICE CLASSIFICATION D. SELECTIVE SERVICE REGISTRATION NO.
B. PRIOR SERVICE:
PROCESSING FOR
YES

NO

NUMBER OF DAYS:

SECTION I - PERSONAL DATA

2. NAME (Last, First, Middle Name (and Maiden, if any), Jr., Sr., etc.)

1. SOCIAL SECURITY NUMBER
3. CURRENT ADDRESS

4. HOME OF RECORD ADDRESS

(Street, City, County,
State, Country, ZIP Code)

(Street, City, County, State,
Country, ZIP Code)

5. CITIZENSHIP (X one)

6. SEX (X one)

a. U.S. AT BIRTH (If this box is marked, also X (1) or (2))
(2) BORN ABROAD OF U.S.
(1) NATIVE BORN
PARENT(S)
b. U.S. NATURALIZED ALIEN REGISTRATION NUMBER
(If issued)
c. U.S. NON-CITIZEN
NATIONAL
d. IMMIGRANT ALIEN (Specify)
e. NON-IMMIGRANT FOREIGN
NATIONAL (Specify)

10. DATE OF BIRTH

a. MALE

(3) BLACK OR AFRICAN
AMERICAN

8. MARITAL STATUS (Specify)

(5) WHITE

9. NUMBER OF DEPENDENTS
13. PROFICIENT IN FOREIGN

12. EDUCATION

1st

LANGUAGE (If Yes, specify.
If No, enter NONE.)

(Yrs/Highest Ed
Gr Completed)

YES

(4) NATIVE HAWAIIAN
OR OTHER PACIFIC
ISLANDER

(2) ASIAN

(2) NOT HISPANIC
OR LATINO

(Optional)

14. VALID DRIVER'S LICENSE (X one)

(1) AMERICAN INDIAN/
ALASKA NATIVE

(1) HISPANIC OR
LATINO

b. FEMALE

11. RELIGIOUS
PREFERENCE

(YYYYMMDD)

7.b. RACIAL CATEGORY (X one or more)

7.a. ETHNIC
CATEGORY

2nd

15. PLACE OF BIRTH (City, State and Country)

NO

(If Yes, list State, number, and expiration date)

NEEDS DD 67

SECTION II - EXAMINATION AND ENTRANCE DATA PROCESSING CODES
(FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SECTION - Go on to Page 2, Question 20.)

16. APTITUDE TEST RESULTS
a. TEST ID b. TEST SCORES

GS

AFQT
PERCENTILE

17. DEP ENLISTMENT DATA

a. DATE OF ENLISTMENT - DEP b. PROJ ACTIVE DUTY DATE
(YYYYMMDD)

h. WAIVER (2)

(3)

(1)

18. ACCESSION DATA

(4)

WK

PC

MK

EI

AS

c. ES d. RECRUITER IDENTIFICATION

(YYYYMMDD)

g. T-E MOS/AFS

AR

(5)

i. PAY
GRADE

(6)

(YYYYMMDD)

AO

e. STN ID

j. SVC ANNEX CODES

b. ACTIVE DUTY SERVICE DATE c. PAY ENTRY DATE (YYYYMMDD) d. MSO (YYWW)

a. DATE OF ENLISTMENT

MC

VE

f. PEF

l. AD OBLIGATION (YYWW)

k. MSO (YYWW)

e. AD/RC OBLIGATION (YYMMWWDD)

(YYYYMMDD)

f. WAIVER (2)
(1)

(3)

(4)

k. RECRUITER IDENTIFICATION
s. SVC ANNEX CODES

(5)

(6)

l. STN ID

g. PAY GRADE

m. PEF

h. DATE OF GRADE (YYYYMMDD)

n. T-E MOS/AFS

o. PMOS/AFS

i. ES

p. YOUTH

j. YRS./HIGHEST

ED GR COMPL

q. OA

r. STATE

GUARD

t. REPLACES ANNEXES u. TRANSFER TO (UIC)

19. SERVICE
REQUIRED
CODES

1

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DD FORM 1966 DRAFT

PREVIOUS EDITION IS OBSOLETE.

Adobe Professional X

PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; 504, Persons Not Qualified; 505, Regular components:
qualifications, term grade; and 12102, Reserve Components; Qualifications; 14 U.S.C. 351, Enlistments; term, grade; and 632, Functions and powers vested in
the Commandant; DoDI 1304.2, Accession Processing Data Collection Forms; DoDI 1304.26, Qualification Standards for Enlistment, Appointment, and
Induction; AR 601-270, OPNAVINST 1100.4C Ch-2, AFI 36-2003_IP, MCO 1100.75E, and COMDTINST M 1100.2E, Military Entrance Processing Station
(MEPS) ; AR 601-210. Active and Reserve Components Enlist Program; AFPD 36-20, Accession of Air Force Military Personnel; and E.O. 9397 (SSN), as
amended.
PRINCIPAL PURPOSE(S): Military recruiters use the information you provide on this form to collect additional information from the individuals, schools, and
employers you list so that we can determine if you meet recruitment standards. If you do meet these standards and enlist, the information you provide on this
form starts your Official Military Personnel File. During the recruiting process we use the information on this form to verify your identity. This form also
contains a section where you are asked to provide your signed consent for your medical provider(s) to release your medical records to the Department of
Defense.
ROUTINE USE(S): To the Selective Service System (SSS) to update the SSS registrant database; To local and statement Government Agencies for
compliance with laws and regulations governing control of communicable diseases. To appropriate agencies, entities, and persons when
(1) the DoD suspects or has confirmed that there has been a breach of the system of records;
(2) the DoD has determined that as a result of the suspected or confirmed breach there is a risk of harm to individuals, the DoD (including its information
systems, programs, and operations), the Federal Government, or national security; and (3) the disclosure made to such agencies, entities, and persons is
reasonably necessary to assist in connection with the DoD’s efforts to respond to the suspected or confirmed breach or to prevent, minimize, or remedy such
harm. To another Federal agency or Federal entity, when the DoD determines that information from this system of records is reasonably necessary to assist
the recipient agency or entity in (1) responding to a suspected or confirmed breach or (2) preventing, minimizing, or remedying the risk of harm to individuals,
the recipient agency or entity (including its information systems, programs and operations), the Federal Government, or national security, resulting from a
suspected or confirmed breach. Other routine uses are listed in the applicable system of records notices listed below.
DISCLOSURE: Voluntary. However, if you fail to provide the requested information you might not be able to enlist. Your Social Security Number is used
during the recruiting process to conduct background screening (e.g., law enforcement, medical, or educational record checks, former employer checks, work
status, etc.). Keep all of your records together during the enlistment process, and ensure your test results are properly recorded.
Applicable system of records notices:
Accession:
U.S. Military Entrance Processing Command:
http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570661/a0601-270-usmepcom-dod/
Army (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570054/a0600-8-104-ahrc/)
Navy (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570316/n01131-1/; http://dpcld.defense.gov/Privacy/SORNsIndex/DODwide-SORN-Article-View/Article/570318/n01133-2/)
Marine Corps (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570628/m01133-3/)
Air Force (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569780/f036-aetc-r/)
Coast Guard (http://edocket.access.gpo.gov/2008/E8-29845.htm)

NEEDS DD 67

Official Military Personnel Files:
Army (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570051/a0600-8-104b-ahrc/; http://dpcld.defense.gov/Privacy/
SORNsIndex/DOD-wide-SORN-Article-View/Article/570052/a0600-8-104b-ngb/)
Navy (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570310/n01070-3/)
Marine Corps (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570626/m01070-6/)
Air Force (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569821/f036-af-pc-c/)
Coast Guard (https://www.govinfo.gov/app/details/FR-2008-12-19/E8-29793)

WARNING
Information provided by you on this form is FOR OFFICIAL USE ONLY and will be maintained and used in strict compliance with Federal laws and
regulations. The information provided by you becomes the property of the United States Government, and it may be consulted throughout your military
service career, particularly whenever either favorable or adverse administrative or disciplinary actions related to you are involved.
YOU CAN BE PUNISHED BY FINE, IMPRISONMENT OR BOTH IF YOU ARE FOUND GUILTY OF MAKING KNOWING AND WILLFUL FALSE
STATEMENT ON THIS DOCUMENT.

INSTRUCTIONS
(Read carefully BEFORE filling out this form.)
1. Read Privacy Act Statement above before completing form.
2. Type or print LEGIBLY all answers. If the answer is “None” or “Not Applicable”, so state. “Optional” questions may be left blank.
3. Unless otherwise specified, write all dates as 8 digits (with no spaces or marks) in YYYYMMDD fashion. June 1, 2014 is written 20140601.

DD FORM 1966 DRAFT

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20. NAME (Last, First, Middle Initial)

21. SOCIAL SECURITY NUMBER

SECTION III - OTHER PERSONAL DATA

22. EDUCATION

a. List all high schools and colleges attended. (List dates in YYYYMM format.)
(1) FROM

(2) TO

(3) NAME OF SCHOOL

(5) GRADUATE
(4) LOCATION

YES

NO

YES

NO

b. Have you ever been enrolled in ROTC, Junior ROTC, Sea Cadet Program or Civil Air Patrol?
23. MARITAL/DEPENDENCY STATUS AND FAMILY DATA
(If "Yes," explain in Section VI, "Remarks.")

a. Is anyone dependent upon you for support?
b. Is there any court order or judgment in effect that directs you to provide alimony or support for children?
c. Do you have an immediate relative (father, mother, brother, or sister) who: (1) is now a prisoner of war or is missing
in action (MIA); or (2) died or became 100% permanently disabled while serving in the Armed Services?

NEEDS DD 67

d. Are you the only living child in your immediate family?

24. PREVIOUS MILITARY SERVICE OR EMPLOYMENT WITH THE U.S. GOVERNMENT
(If "Yes," explain in Section VI, "Remarks.")

a. Are you now or have you ever been in any regular or reserve branch of the Armed Forces or in the Army National Guard
or Air National Guard?
b. Have you ever been rejected for enlistment, reenlistment, or induction by any branch of the Armed Forces of the United
States?
c. Are you now or have you ever been a deserter from any branch of the Armed Forces of the United States?
d. Have you ever been employed by the United States Government?
e. Are you now drawing, or do you have an application pending, or approval for: retired pay, disability allowance, severance
pay, or a pension from any agency of the government of the United States?
25. ABILITY TO PERFORM MILITARY DUTIES
(If "Yes," explain in Section VI, "Remarks.")

a. Are you now or have you ever been a conscientious objector? (That is, do you have, or have you ever had, a firm, fixed,
and sincere objection to participation in war in any form or to the bearing of arms because of religious belief or training?)
b. Have you ever been discharged by any branch of the Armed Forces of the United States for reasons pertaining to being a
conscientious objector?
c. Is there anything which would preclude you from performing military duties or participating in military activities whenever
necessary (i.e., do you have any personal restrictions or religious practices which would restrict your availability)?
26. DRUG USE AND ABUSE (If "Yes," explain in Section VI, "Remarks.")
Have you ever tried, used, sold, supplied, or possessed any narcotic (to include heroin or cocaine), depressant (to include
quaaludes), stimulant, hallucinogen (to include LSD or PCP), or cannabis (to include marijuana or hashish), or any
mind-altering substance (to include glue or paint), or anabolic steroid, except as prescribed by a licenced physician?

DD FORM 1966 DRAFT

Page 2

27. NAME (Last, First, Middle Initial)

28. SOCIAL SECURITY NUMBER

SECTION IV - CERTIFICATION
29. CERTIFICATION OF APPLICANT (Your signature in this block must be witnessed by your recruiter.)

a. I certify that the information given by me in this document is true, complete, and correct to the best of my knowledge and belief.
I understand that I am being accepted for enlistment based on the information provided by me in this document; that if any of the
information is knowingly false or incorrect, I could be tried in a civilian or military court and could receive a less than honorable
discharge which could affect my future employment opportunities.
b. TYPED OR PRINTED NAME (Last, First, Middle
Initial)

c. SIGNATURE

d. DATE SIGNED (YYYYMMDD)

30. DATA VERIFICATION BY RECRUITER (Enter description of the actual documents used to verify the following items.)
a. NAME (X one)

b. AGE (X one)

(1) BIRTH CERTIFICATE

(1) BIRTH CERTIFICATE

(2) OTHER (Explain)

(2) OTHER (Explain)

d. SOCIAL SECURITY NUMBER (SSN) (X one)

c. CITIZENSHIP (X one)
(1) BIRTH CERTIFICATE
(2) OTHER (Explain)
f. OTHER DOCUMENTS USED

e. EDUCATION (X one)

(1) SSN CARD

(1) DIPLOMA

(2) OTHER (Explain)

(2) OTHER (Explain)

31. CERTIFICATION OF WITNESS
a. I certify that I have witnessed the applicant's signature above and that I have verified the data in the documents required as prescribed by my
directives. I further certify that I have not made any promises or guarantees other than those listed and signed by me. I understand my liability to
trial by courts-martial under the Uniform Code of Military Justice should I effect or cause to be effected the enlistment of anyone known by me to
be ineligible for enlistment.
b. TYPED OR PRINTED NAME (Last, First,
Middle Initial)

c. PAY
GRADE

d. RECRUITER I.D.

e. SIGNATURE

f. DATE SIGNED
(YYYYMMDD)

32. SPECIFIC OPTION/PROGRAM ENLISTED FOR, MILITARY SKILL, OR ASSIGNMENT TO A GEOGRAPHICAL AREA GUARANTEES

NEEDS DD 67

a. SPECIFIC OPTION/PROGRAM ENLISTED FOR (Completed by Guidance Counselor, MEPS Liaison NCO, etc., as specified by sponsoring service.)
(Use clear text English.)

b. I fully understand that I will not be guaranteed any specific military skill or assignment to a geographic area except
as shown in Item 32.a. above and annexes attached to my Enlistment/Reenlistment Document (DD Form 4).

c. APPLICANT'S
INITIALS

33. CERTIFICATION OF RECRUITER OR ACCEPTOR
a. I certify that I have reviewed all information contained in this document and, to the best of my judgment and belief, the applicant fulfills all legal
policy requirements for enlistment. I accept him/her for enlistment on behalf of the United States (Enter Branch of Service)
and certify that I have not made any promises or guarantees other than those listed in Item 32.a.
above. I further certify that service regulations governing such enlistments have been strictly complied with and any waivers required to effect
applicant's enlistment have been secured and are attached to this document.
b. TYPED OR PRINTED NAME (Last, First,
Middle Initial)

c. PAY
GRADE

d. RECRUITER I.D. OR
ORGANIZATION

e. SIGNATURE

f. DATE SIGNED
(YYYYMMDD)

SECTION V - RECERTIFICATION
34. RECERTIFICATION BY APPLICANT AND CORRECTION OF DATA AT THE TIME OF ACTIVE DUTY ENTRY
a. I have reviewed all information contained in this document this date. That information is still correct and true to the best of my knowledge and
belief. If changes were required, the original entry has been marked "See Item 34" and the correct information is provided below.
b. ITEM NUMBER

c. CHANGE REQUIRED

d. APPLICANT
(1) SIGNATURE

DD FORM 1966 DRAFT

e. WITNESS
(2) DATE SIGNED
(YYYYMMDD)

(1) TYPED OR PRINTED NAME (Last,
First, Middle Initial)

(2) RANK/ (3) SIGNATURE
GRADE

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35. NAME (Last, First, Middle Initial)

36. SOCIAL SECURITY NUMBER

SECTION VI - REMARKS
(Specify item(s) being continued by item number. Continue on separate pages if necessary.)

NEEDS DD 67
DD FORM 1966/5
ATTACHED? (X one)

SECTION VII - STATEMENT OF NAME FOR OFFICIAL MILITARY RECORDS

YES
NO

37. NAME CHANGE.
If the preferred enlistment name (name given in Item 2) is not the same as on your birth certificate, and it has not been changed by legal procedure
prescribed by state law, and it is the same as on your social security number card, complete the following:
a. NAME AS SHOWN ON BIRTH CERTIFICATE

b. NAME AS SHOWN ON SOCIAL SECURITY NUMBER CARD

c. I hereby state that I have not changed my name through any court or other legal procedure; that I prefer to use the name of
by which I am known in the community as a matter of convenience
and with no criminal intent. I further state that I am the same person as the person whose name is shown in Item 2.
d. APPLICANT
(1) SIGNATURE

(2) DATE SIGNED
(YYYYMMDD)

e. WITNESS
(1) TYPED OR PRINTED NAME (Last, First, Middle Initial)

DD FORM 1966 DRAFT

(2) PAY GRADE

(3) SIGNATURE

Page 4

38. NAME (Last, First, Middle Initial)

39. SOCIAL SECURITY NUMBER

USE THIS DD FORM 1966 PAGE ONLY IF EITHER SECTION APPLIES TO THE APPLICANT'S RECORD OF MILITARY PROCESSING.

SECTION VIII - PARENTAL/GUARDIAN CONSENT FOR ENLISTMENT
40. PARENT/GUARDIAN STATEMENT(S) (Line out portions not applicable)

a. I/we certify that (Enter name of applicant)
has no other legal guardian other than me/us and I/we consent to his/her enlistment in the United States
(Enter Branch of Service)

I/we acknowledge/understand that he/she may be required upon order to serve in combat or other hazardous
situations. I/we certify that no promises of any kind have been made to me/us concerning assignment to duty,
training, or promotion during his/her enlistment as an inducement to me/us to sign this consent. I/we hereby authorize
the Armed Forces representatives concerned to perform medical examinations, other examinations required, and to
conduct records checks to determine his/her eligibility. I/we relinquish all claim to his/her service and to any wage or
compensation for such service. I/we authorize him/her to be transported unsupervised to/from the Military Entrance
Processing Station via public conveyance and to stay unsupervised at a government contracted hotel facility.

b. FOR ENLISTMENT IN A RESERVE COMPONENT.

NEEDS DD 67

I/we understand that, as a member of a reserve component, he/she must serve minimum periods of active duty for
training unless excused by competent authority. In the event he/she fails to fulfill the obligations of his/her reserve
enlistment, he/she may be recalled to active duty as prescribed by law. I/we further understand that while he/she is in
the ready reserve, he/she may be ordered to extended active duty in time of war or national emergency declared by
the Congress or the President or when otherwise authorized by law, and may be required upon order to serve in
combat or other hazardous situations.
c. PARENT
(1) TYPED OR PRINTED NAME (Last, First, Middle Initial)

(2) SIGNATURE

(3) DATE SIGNED
(YYYYMMDD)

(2) SIGNATURE

(3) DATE SIGNED
(YYYYMMDD)

(2) SIGNATURE

(3) DATE SIGNED
(YYYYMMDD)

(2) SIGNATURE

(3) DATE SIGNED
(YYYYMMDD)

d. WITNESS
(1) TYPED OR PRINTED NAME (Last, First, Middle Initial)

e. PARENT
(1) TYPED OR PRINTED NAME (Last, First, Middle Initial)

f. WITNESS
(1) TYPED OR PRINTED NAME (Last, First, Middle Initial)

41. VERIFICATION OF SINGLE SIGNATURE CONSENT

DD FORM 1966 DRAFT

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