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pdfOMB No. 0702-0060
OMB Approval Expiration
MMM DD, YYYY
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0702-0060, is estimated to average 251 ( (195 minutes for the Candidate Phase and 56 minutes for
the Accepted Candidate phase) 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 the burden estimate or burden reduction suggestions 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.
PRIVACY ACT STATEMENT AUTHORITY: Title 5 United Sates Code, Government Organization and Employees, Ch 403, Sec 4346; Ch 505, Sec 5031; Ch 603, Sec 6958; Title
44, United States Code, Public Printing and Documents, Ch 31, Sec 3101; Executive Order 9397, Numbering System for Federal Accounts Relating to Individual Persons.
PRINCIPAL PURPOSE: Collection of data on Academy candidates for opening a file. ROUTINE USE: To gather information on a candidate in order to open a file for admissions to
the United States Military. DISCLOSURE IS VOLUNTARY. However, failure to provide information could preclude appointment. In addition to those disclosures generally
permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5
U.S.C. 552a(b)(3) as follows: Academic transcripts may be provided to educational institutions for the purpose of admissions to further educational degree programs. The
DoD Blanket Routine Uses set forth at the beginning of the Army's compilation of systems of records notices also apply to this system.
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INSTRUCTIONS: The instructions for completing all required portions should be followed closely to ensure accurate data collection, and to preclude over-collection of
information. Instructions for completing all the required forms can be found in the Instructions of Applicants Offer Admissions booklet located on the candidate portal page.
AGENCY DISCLOSURE NOTICE The public reporting burden for this collection of information, 0702-0060, is estimated to average 195 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc- [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.
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PRIVACY ACT STATEMENT AUTHORITY: Title 5 United Sates Code, Government Organization and Employees, Ch 403, Sec 4346; Ch 505, Sec 5031; Ch 603, Sec 6958; Title 44,
United States Code, Public Printing and Documents, Ch 31, Sec 3101; Executive Order 9397, Numbering System for Federal Accounts Relating to Individual Persons.
PRINCIPAL PURPOSE: Collection of data on Academy candidates for opening a file. ROUTINE USE: To gather information on a candidate in order to open a file for admissions to the
United States Military. DISCLOSURE IS VOLUNTARY. However, failure to provide information could preclude appointment. In addition to those disclosures generally permitted under
5 U.S.C. 552a(b) of the Privacy Act of 1974, these records contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:
Academic transcripts may be provided to educational institutions for the purpose of admissions to further educational degree programs. The DoD Blanket Routine Uses set forth at the
beginning of the Army's compilation of systems of records notices also apply to this system.
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The AGENCY DISCLOSURE NOTICE – The public reporting burden for this collection of information, 0702-0060, is estimated to average 5 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 the burden estimate or burden reduction suggestions to the
Department of Defense, Washington Headquarters Services, at [email protected]. Respondents
should be aware that notwithstanding any other provision of the 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.
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PRIVACY ACT STATEMENT. AUTHORITY: Title 5 USC, Ch 301: Title 10 USC Ch 403 Sec 4346, Ch 503, Ch 505 Sec 5031, Ch 603 Sec 6958: Title 44 USC
3101: e. ROUTINE USE: To gather information on a candidate in order to open a file for admission to West Point. DISCLOSURE IS VOLUNTARY.
However, failure to provide information could preclude appointment.
Employer’s Evaluation of Candidate
OMB No. 0702-0060
OMB Approval Expiration
MMM DD, YYYY
AGENCY DISCLOSURE NOTICE – The public reporting burden for this collection of information, 0702-0061, is estimated to average 10 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 the burden estimate or burden reduction suggestions 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.
PRIVACY ACT STATEMENT AUTHORITY: Title 5 United Sates Code, Government Organization and Employees, Ch 403, Sec 4346; Ch 505, Sec 5031; Ch 603,
Sec 6958; Title 44, United States Code, Public Printing and Documents, Ch 31, Sec 3101; Executive Order 9397, Numbering System for Federal Accounts Relating
to Individual Persons. PRINCIPAL PURPOSE: Collection of data on Academy candidates for opening a file. ROUTINE USE: To gather information on a candidate
in order to open a file for admissions to the United States Military. DISCLOSURE IS VOLUNTARY. However, failure to provide information could preclude
appointment. In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records contained therein may specifically
be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: Academic transcripts may be provided to educational institutions for the
purpose of admissions to further educational degree programs. The DoD Blanket Routine Uses set forth at the beginning of the Army's compilation of systems of
records notices also apply to this system.
INSTRUCTIONS
The instructions for completing the Employer’s Evaluation of Candidate (EEC) should be followed closely to ensure accurate data collection, and to preclude overcollection of information. Instructions for the EEC can be found at https://candidate.usma.edu/downloads/CY2021/InstructionsForApplicants.pdf
CANDIDATE ID NUMBER
C
M.I.
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FIRST NAME
LAST NAME
SOCIAL SECURITY NUMBER
STATE
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INSTRUCTIONS FOR THE EMPLOYER/SUPERVISOR: The above-named individual is applying for admission to the United States Military Academy. Please complete this form as accurately as
possible and return it directly to West Point in the envelope provided.
1. I employed the candidate during the following period(s):
From ............................... To .................................
(Month, Day, Year)
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(Month, Day, Year)
From ............................... To .................................
(Month, Day, Year)
(Month, Day, Year)
2. Total number of hours worked per week during the following
periods:
September-May
Mon-Fri...............Sat/Sun ................
June-August
Mon-Fri...............Sat/Sun ................
3. Briefly describe the type of work performed by the candidate.
4. Please evaluate the following factors concerning the candidate. Mark only one choice for each item. Rate the items on how
well the quality describes the candidate by using the following scale:
1 - Superior, 2 - Above Average, 3 - Average, 4 - Below Average, 5 - Inferior
1
2
3
4
5
1
A. Cooperation
G. Initiative
B. Dependability
H. Plans and organizes work
C. Productivity
I. Potential for advancement
D. Attitude
J. Capacity for leadership
E. Emotional Stability
K. Attendance and punctuality
F. Consideration for others
USMA Form 5-518 (Rev Dec 2019)
2
3
4
5
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5. REMARKS:
You have the right to request confidentiality as a condition for providing information about this candidate. Otherwise, your identity and remarks may be disclosed at the candidate’s request. Do you stipulate confidentiality?
Yes
No
NAME AND ADDRESS OF EMPLOYER
TELEPHONE NUMBER
SIGNATURE OF EMPLOYER/SUPERVISOR
DATE
USMA Form 5-518 (Rev Dec 2019)
WEST POINT ADMISSIONS INTERVIEW REPORT DATE
OMB No. 0702-0060
OMB Approval Expiration
MM DD, YYYY
NAME OF APPLICANT (Last Name, First, MI)
CANDIDATE ID
CONG. DISTRICT
ADDRESS (Include zip code)
CURRENT SCHOOL
YEAR IN H.S.
E-MAIL
PHONE(S)
The AGENCY DISCLOSURE NOTICE – The public reporting burden for this collection of information, 0702-0061,is estimated to average 30
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 the burden estimate or burden reduction
suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of the 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.
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PRIVACY ACT STATEMENT AUTHORITY: Title 5 United Sates Code, Government Organization and Employees, Ch 403, Sec 4346; Ch 505, Sec
5031; Ch 603, Sec 6958; Title 44, United States Code, Public Printing and Documents, Ch 31, Sec 3101; Executive Order 9397, Numbering
System for Federal Accounts Relating to Individual Persons. PRINCIPAL PURPOSE: Collection of data on Academy candidates for opening a
file. ROUTINE USE: To gather information on a candidate in order to open a file for admissions to the United States Military. DISCLOSURE
IS VOLUNTARY. However, failure to provide information could preclude appointment. In addition to those disclosures generally permitted
under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records contained therein may specifically be disclosed outside the DoD as a
routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: Academic transcripts may be provided to educational institutions for the purpose of
admissions to further educational degree programs. The DoD Blanket Routine Uses set forth at the beginning of the Army's compilation of
systems of records notices also apply to this system.
YES
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1. Appropriately Dressed?
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INSTRUCTIONS: At the beginning of the interview, the candidate must be told that the interview is authorized by Title 10 U.S. Code, Ch 403
Sec 4346, Ch 503, Ch 505 Sec 5031, Ch 603 Section 6958: Title 44 USC 3101: E09397. DO NOT duplicate reporting of information that is
correct on the current monthly Candidate Referral Report. Instead, emphasize the identification of problem areas that you or an Admissions
Officer can assist in resolving. Probe for characteristics of the applicant that might not be properly revealed on the various application forms,
such as desire to excel and persevere. Try to get an impression of the applicant’s willingness to complete the West Point programs and serve
as an Army officer, but do not expect the applicant to be committed to an Army career. Do you require confidentiality as a condition for
providing information?
YES
NO
3. Issues Scheduling Interview?
NO
YES
NO
4. Counselor Present (in school)? YES
NO
2. Has Resume?
NO
5. Parents Present?
10. Candidate has access to their
YES
portal?
YES
NO
YES
NO
YES
NO
YES
NO
Remarks:
8. Candidate understands the medical and medical waiver process?
9. Planned SAT Dates:
NO
Remarks:
6. Candidate knows how/has contacted congressional and senate offices?
7. Eligible for service connected
YES
nomination?
YES
Planned ACT Dates:
NO
Remarks:
11. Candidate understands the appropriate points of contact for each application item?
AREA TO BE
RATED
1
2
3
4
5
6
RATING
Fine student.
Solid average
Honors at college. student. Possible
honors.
Capable of passing Marginal ability,
work.
or questionable
motivation.
Poor academic
risk.
Extracurricular Outstanding
Activity (other leader in “top”
than athletic) activities.
Major office
holder. Makes a
real contribution
Good citizen,
interested and
active.
Fairly active,
minor offices
and/or minor
activities.
Minor
participation, no
offices.
No activities.
Athletic Ability Outstanding
Fine high school
athlete, varsity
letter.
HS varsity
participation,
healthy interest.
Intramural
participation,
healthy interest.
Sports are a
pastime.
No interest.
Good above
Generally OK. No
average applicant. strengths, no
weaknesses.
Not very
appealing.
Immature.
Poor impression.
Unstable or
offensive.
Strong contender. Reasonable
possibility for
admission.
Questionable
admission.
Not
recommended for
admission.
Academic
Ability
Exceptionally
Promising.
college varsity
prospect.
Personal
Qualities
Outstanding
Great appeal.
person. Tops in all Generally, very
respects.
strong.
Overall Rating Top candidate for Clearly admit.
admission.
STANDARDIZED INTERVIEW QUESTIONS:
Please record abbreviated responses along with a score to
capture the strength of the candidate's response. Most
selections should be 0.
Select 1 for each answer: 0 = Sufficient, X Concerns, + = Excellent
X
0
+
Concerns with answer
Sufficient Answer
Excellent Answer
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1. To what other schools are you applying?
2. Do you know about Army ROTC options for these schools?
3. What is your preference among Academies? USMA
USAFA
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Why?
USNA
4. Where do you see yourself in 10 years?
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5. How does West Point fit into those goals?
6. What major are you most interested in and why?
7. How does the Army fit into those goals?
8. What branch are you most interested in and why?
9. How is leadership important to an organization?
10. What is the most important leadership trait?
11. Describe an instance when your leadership made a difference in a situation.
12. If you could have any three teammates to complete a project, who would they be and why?
USCGA
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=
INTERVIEWER’S COMMENTS: If work or family problems affected this applicant’s performance, please make special annotation below. Also
comment on BEARING and APPEARANCE, PERSONAL MAGNETISM, and how the applicant became interested in USMA. Would you select this
candidate over another for USMA, USMAPS and/or Civil Prep? Why? Include any other comments that will assist USMA faculty.
NAME AND TITLE OF INTERVIEWER
EMAIL / PHONE
SIGNATURE
| File Type | application/pdf |
| File Modified | 2019-12-11 |
| File Created | 2018-08-27 |