W. Va. Code R. § 141-35-23
APPLICATION FOR ENROLLMENT-WEST VIRGINIA OFFICER CANDIDATE SCHOOL
1. ___________________________ ____________
(last name, first name, middle name) (grade)
____________ ____________
(ssan) (unit)
___________________________ ____________
(home address, include zip code) (home phone)
___________________________ ____________
(business address, include zip code) (business phone)
2. The following information is correct to the best of my knowledge:
___________________________ ____________
(date of birth) (place of birth: city, county, state)
Civilian Education: (if still attending, enter "ATNG" by Graduate)
High School: ________________________ Years _____ Graduate ______
College: ____________________________ Years _____ Graduate ______
Other: ______________________________ Years _____ Graduate ______
Record of ACTIVE Military Service (Include RFA 55 and REP 63 ACDUTRA):
PROM TO STATION LAST UNIT ASGMT DUTY
_______________________________________
_______________________________________
_______________________________________
Military service other than above (National Guard, USAR, etc.)* Include present service. Show component (ARNG, USAR, USNR, etc. and dates.
_______________________________________
_______________________________________
_______________________________________
AGO Form 351-5-1, 31 OCT 91 Previous Editions are Obselete
3. READ CAREFULLY AND ANSWER TRUTHFULLY: Were you ever arrested, charged or held by Federal, State, or other law enforcement authorities for any violation of any Federal Law, State Law, County, or Minicipal Law, regulation or ordinance or were you ever convicted of a felony or any other offense, or adjusted a youth offender or juvenile delinquent (including violations of local ordinance)*, or were you ever imprisioned under sentence of any court, or were you ever convicted by any court martial, or are you now or were you ever on a suspended sentence, parole, probation or are you waiting final action on charges against you? (Yes/No) If your answer to any question is "Yes", attach a full explanation.
*NOTE: Traffic offenses which result in fine of forfeiture of $50.00 or less are not considered violations of local ordinances for this purpose.
4. I understand that I will be required to attend two (2) field training phases of fifteen (15) days and as a minimum, fifty-two (52) Inactive Duty Training Assemblies (IDT) prior to completion of Officer Candidate Training. I further understand that I must become branch qualified not later that twelve (12) months after receiving my commission as a Second Lieutenant (2LT).
5. I certify that, to the best of my knowledge, I have no physical disability which would disqualify me for appointment as a commissioned officer. (If you have any question in your mind, have your unit administrator check the requirements of AR 40-501.)
(signature)
1st End
TO: President, OCS Screening Board, ___________ ___________
(UNIT) (DATE)
1. Approval (recommended/not recommended). If not recommended, attach explanation.
2. If this individual is commissioned, I would/would not be happy to have him/her serve as an Officer under my command.
3. Applicant has attained the following scores:
a. GT:__________
b. OSB:_________
4. Applicant has attained the following standards necessary for enrollment in OCS:
a. Has completed the required college hours: YES___ NO___
b. Is of good moral character: YES___ NO___
c. Is at least 18 years of age: YES___ NO___
d. Will complete OCS prior to age 30: YES___ NO___
e. Has favorable NAC or NAC has been initiated: YES___ NO___
f. Has completed BCT and AIT: YES___ NO___
g. Has no civilian or military offenses: YES___ NO___
"NOTE: Items 3b, 4a, 4d, and 4g may be waived under exceptional circumstances. Submit waivers as enclosures to the application.
5. Individual's military sponsor: ____________________________
(NAME/GRADE)
____________________________
(Signature of Unit Commander)
____________________________
.(Typed Name, Grade, and Branch)
2d End SUBJECT: Application for Enrollment, West Virginia Officer Candidate School
_____________________________________ Date _________________ ,.
FOR Commandant, WV Military Academy, 240 Army Road, Kingwood, WV 26537-1077
The OCS Screening Board of this headquarters has examined the following Candidate for attendance at the West Virginia Officer Candidate School with the results indicated:
_____________________________________ ______________
(last name, first name, middle initial) (ssan)
a. Has leadership potential: Yes ___ No ___
b. Has proper military appearance: Yes ___ No ___
c. Possesses good military bearing: Yes ___ No ___
d. Is able to express him/her self will orally: Yes ___ No ___
e. Demonstrates proficiency in the English language: Yes ___ No ___
f. Is motivated to be an officer: Yes ___ No ___
g. Is of good moral character: Yes ___ No ___
h. Has the required college hours for enrollment: Yes ___ No ___
i. Is at least 18 years of age: Yes ___ No ___
j. Will complete OCS prior to age 30: Yes ___ No ___
k. Has favorable NAC or NAC has been initiated: Yes ___ No ___
l. Has completed BCT and AIT: Yes ___ No ___
m. Has no civilian or military offenses: Yes ___ No ___
n. Understands the physical and mental demands of OCS: Yes ___ No __
*N0TE: Items j and m, may, under exceptional circumstances, be waived (Unit should initiate the waiver IAW NGR 351-5, para 2-27). Waiver/s enclosed as required: Yes ____ No ____ N/A ____
We recommend that he/she be/not be admitted to the Academy.
_____________________________________
(signature and grade of Screening Board President)
_____________________________________
(signature and.grade of Screening Board member)
_____________________________________
(signature and grade of Screening Board Recorder)
W. Va. Code R. § 141-35-23