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Prospect Applicant Questionnaire

OMB Control # 1625-0128 Expiration Date: September 30, 2021

  • Current Contact Details and Interest
  • Biographical Details
  • Military and ASVAB Information
  • Additional Background Information
  • Review Application
Privacy Act Statement

AUTHORITY: < 10 U.S.C. §§ 504, 1475-1480; 14 U.S.C. §§ 211, 350, 632; Homeland Security Presidential Directive (HSPD) 12; Executive Order 9397.

PURPOSE:To identify and process individuals interested in applying for enlistment or commission in the United States Coast Guard (CG) or CG Reserve.

ROUTINE USES: Authorized CG personnel will use this information to assess an individual s interest for enlistment and/or commissioning, to screen qualified applicants, and to initiate pay and benefits for new members. Any external disclosures of data within this record will be made in accordance with DHS/USCG-014, Military Pay and Personnel System of Records, 76 Federal Register 66,933, October 28, 2011.

DISCLOSURE: Disclosure is voluntary. However, failure to provide requested information may result in not being contacted by a recruiter and ultimately, prohibit enlistment or commissioning.

Paperwork Reduction Act Statement

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.

The Coast Guard estimates that the average burden to complete this form is 30 minutes.

You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commanding Officer, Coast Guard Recruiting Command, 2703 Martin Luther King Jr. Ave SE, Washington, DC 20593-7419 or Office of Management and Budget, Paperwork Reduction Project (1625-new), Washington DC 20503.

Contact Details and Interest

If no Maiden name, leave blank.
Current Address
No PO Box.
Contact Information