NAVCRUIT Form 1131 Application Processing and Summary Record

Application Processing and Summary Record
NAVCRUIT 1131/238 (Rev. 10-2019)

OMB CONTROL NUMBER: 0703-0029
OMB EXPIRATION DATE: 10/31/2022
Supporting Directive COMNAVCRUITCOMINST 1131.2G

PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations, 10 U.S.C. Sections governing authority to appoint officers; 10 U.S C. 591, 600, 716, 2107,
2122, 5579, 5600; Merchant Marine Act of 1939 (as amended); and E.O.s 9397, 10450, and 11652
PRINCIPAL PURPOSES: To manage and contribute to the recruitment of qualified men and women for officer programs and the regular and reserve
components of the Navy. To ensure quality military recruitment and to maintain records pertaining to the applicant's personal profile for purposes of
evaluation for fitness for commissioned service.
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information
contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:
To the Department of Transportation in the performance of their official duties relating to the recruitment of Merchant Marine personnel, to
the Veterans Administration and Selective Service Administration in the performance of their official duties related to enlistment and
reenlistment eligibility and related benefits, and to other departments and agencies of the Executive Branch of government in the
performance of their official duties related to the management of quality military recruitment as published in the Federal Register.
DISCLOSURE: Disclosure is voluntary, however, without this information, your entry into the Navy Reserve Officer - Special Duty Public Affairs (1655)
program may not be accomplished. A social security number is necessary to make positive identification of the individual and to permit this service
agreement to become part of the official service record.
________________________________________________________________________________________________________________________
Agency Disclosure Notice
The public reporting burden for this collection of information, OMB 0703-0029 is estimated to average 1 hour 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.
APPLICATION PROCESSING AND SUMMARY RECORD
(YOU MUST ENABLE JAVA TO COMPLETE THIS FORM)
1. PERSONNEL INFORMATION
a. NAVCRUITDIST
b. Last Name
f. SSN
m. Wt.

c. First Name

d. Middle Name or NMN

g. Place of Birth (City, State or Foreign Country) h. DOB
n. Body Fat

o. Race

r. If dual, list country s. Enlisted

i. Age

e. Suffix/Maiden

k. Sex

j. Age waiver req.

p. Ethnicity

l. Ht.

q. Citizenship

t. SKED to ship to RTC u. Interview Scores
Choice 2

Choice 1

Choice 3

Choice 4

Choice 5

v. Program
w. NOBC/SSP
2. MILITARY SERVICE
a. Current MIL Status

b. Branch

c. Paygrade

d. Prior Service

e. Branch

f. Paygrade

3. EDUCATIONAL STATUS - Most Current
a. Name of Educational Institution

b. Major (Continue in block 15) c. Edu/Grad. Level

4. TESTING
a. AQR b. PFAR

f. Scores:

c. FOFAR d. OAR e. Other Test :

5. COMMISSIONING DATA

Test Date

d. GPA

g. Avail date for OCS/ODS/SELRES

e. Grad Date

h. Recon

***** NRC USE ONLY*********
b. Grade

a. Commissioning Program

c. Date of Rank d. Desig. e. Type

f. Scroll Sub Date

g. Scroll App Date

h. Original Source Code:
i. Current Source Code:
j. Restrictions:

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k. Restrictions:

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l. Restrictions:

m. Restrictions:

n. Restrictions:

FOR OFFICIAL USE ONLY
PRIVACY SENSITIVE

o. Restrictions:

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Application Processing and Summary Record
NAVCRUIT 1131/238 (Rev. 10-2019)

OMB CONTROL NUMBER: 0703-0029
OMB EXPIRATION DATE: 10/31/2022
Supporting Directive COMNAVCRUITCOMINST 1131.2G
BUPERS USE ONLY

Authority:
Authority:

Remarks
Remarks

PC:
PC:

OSD
OSD APP
APP

SECNAV
SECNAV APP
APP

Senate
Senate Confirmed
Confirmed

Date
Date Approved
Approved

Null
Null && Void
Void Date
Date

6. COMPENSATION/ALLOWANCES AND PENSIONS
DUAL COMPENSATION STATEMENT AND WAIVER OF CLAIM: I understand that if I execute an enlistment into an Officer Candidate program or receive a commission in
the U.S. Navy or Navy Reserve, I may not draw any of the compensation prescribed for active duty, active duty for training, or inactive duty training for the same period that I
am drawing or claiming a pension/ retirement/ retainer pay, or disability compensation from the U.S. Government by virtue of prior military service. Therefore, I hereby
voluntarily agree to waive the pension/ retirement/ retainer pay or disability compensation I am receiving effective at the time I begin receiving any compensation for active
duty, active duty for training, or inactive duty training.
Applicant's Initials:

No Yes

Enter additional remarks in block 15
a. Have you ever claimed or been granted a pension/ disability allowance/ disability compensation/ or retirement pay from the U.S. Govt?

b. Are you presently receiving such compensation? If Yes, explain in the Remarks section and initial statement in block 6.
7. EYE SURGERY
a. Have you ever had eye surgery? (Include Radial Keratotomy (RK), Photorefractive Keratectomy (PRK) or Laser in Situ Keratomileuisi
(LASIK) procedures) If "YES", ensure pre-op, operative, and two post-op exams are included with physical.
8. SWIMMING ABILITY
a. Can you swim 50 yards using any combination of the crawl, breast, side and/or the back strokes?
b. Abandon ship jump: Can you jump from a 12-ft tower to simulate abandoning ship?
c. Can you remain afloat for 5 minutes (prone position)? Remain afloat (face down), utilizing survival-floating skills?
d. Shirt and trouser inflation: Can you fill a shirt and pair of trousers with air to remain afloat?
If any of the preceding questions are answered no, ensure that you are issued the "Officer Candidate School/Officer Development School Third Class
Swim Test Letter" and that you initial acknowledgement of the letter.
Applicant's Initials:

9. ILLEGAL ACTIVITIES
a. Have you ever been charged of a crime to include drug or alcohol use?
b. Have you ever used illegal drugs?
c. Have you ever been charged with domestic violence?
d. Have you ever filed bankruptcy?
10. CURRENT PHYSICAL FITNESS PROGRAM (If none enter N/A)
Activity
Frequency

11. PROFESSIONAL LICENSES (up to 4 licenses) (If none enter N/A)
License Name
Expiration Date

Date Commenced (YYYYMMMDD)

License Name

12. FLYING EXPERIENCE ( If none enter N/A)
License/Ratings

Expiration Date

Model

13. FOREIGN LANGUAGE SKILLS (If none enter N/A)
Language

How Acquired (school, family, etc)

Hours

Language Proficiency

14. EXTRA CURRICULAR ACTIVITIES/ORGANIZATIONS/CLUBS/SPORTS HS = High School/C = College/PC= Post College
Activity
Period
# Years
Office Held

15. APPLICANT'S REMARKS (Limited to the visible area.)

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FOR OFFICIAL USE ONLY
PRIVACY SENSITIVE

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Application Processing and Summary Record
NAVCRUIT 1131/238 (Rev. 10-2019)

OMB CONTROL NUMBER: 0703-0029
OMB EXPIRATION DATE: 10/31/2022
Supporting Directive COMNAVCRUITCOMINST 1131.2G

15. APPLICANT'S REMARKS CONT. (Limited to the visible area.)

16. APPLICANT'S MOTIVATIONAL STATEMENT (Limited to the visible area.)

I certify that all statements made in this application and any additional statements pertaining to it are entirely true and complete to the best of my
knowledge and belief. I understand that failure to answer any correspondence accurately or promptly, or failure to accept an appointment tendered to
me will subject my application or appointment to cancellation without further notice.
17. Applicant's Name

18. Applicant's Signature

19. Applicant's Tele. Number

20. Date

Applicant's Email

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Page 3 of 4

Application Processing and Summary Record
NAVCRUIT 1131/238 (Rev. 10-2019)

OMB CONTROL NUMBER: 0703-0029
OMB EXPIRATION DATE: 10/31/2022
Supporting Directive COMNAVCRUITCOMINST 1131.2G

21. OFFICER RECRUITER'S REMARKS (Limited to the visible area.)

22. OFFICER PROCESSOR'S SUMMARY (Limited to the visible area.)

23. OFFICER PROGRAMS OFFICER (OPO) REMARKS (Limited to the visible area.)

24. Based upon all available information, it is my opinion that the applicant is recommended as follows for appointment in the U.S. Navy or U.S. Navy
Reserve for the programs listed above in order of preference listed.
Highly Recommended
Recommended
Not Recommended
25. Recruiting Personnel Certification
I certify that the information contained on this document, to include my personal remarks, are true and accurate to the best of my ability.
I also understand that information from this form will be used to create documents for the OFFICIAL PERSONNEL RECORD. ALL information
provided in this document has been verified against the proper source documents (ie. Birth Certificates and SSN Cards) and is accurate to include
the proper spelling of the applicant's complete name and SSN.
26. Date

27. Recruiter's Telephone Number (Include area code)

28. Recruiter's Name

29. Date

30. Processor's Telephone Number (Include area code)

31. Processor's Name

32. Date

33. OPO's Telephone Number (Include area code)

34. OPO's Name

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FOR OFFICIAL USE ONLY
PRIVACY SENSITIVE

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