WARRIOR CHALLENGE CANDIDATE INTERVIEW QUESTIONNAIRE

The following questions are used to determine your possible eligibility for the US Naval Special Warfare/Operations. You must understand that to gain and maintain eligibility, you must make a very serious and consistent commitment in order to prepare yourself physically and mentally for these programs.

The Warrior Challenge Program offers qualified applicants an opportunity to serve in one of the following ratings: SO-SEAL, SWCC-Special Warfare Boat Operator, EOD-Explosive Ordnance Disposal, ND-Navy Diver, AIRR-Aircrew Rescue Swimmer.

What is your name? _______________________________________________________________________

First MI Last

Cell phone number: _______________________ Email address: __________________________________

RECRUITER NAME: ___________________________STATION__________________ PH____________

Which of the five rates are you interested in (CIRCLE one only)?

SEAL SWCC EOD Diver AIRR

Brief explanation why:

Are you interested in a second program? ______ if yes, Give a brief explanation why?

Have you been fully briefed and showed the material (IE videos) for all five Warrior challenge programs?

Where did you find out about the Warrior Challenge rates and when did you decide to pursue this career path?

What is your current age? ______ What is your height/weight? ______/_______

Have you played or are you playing any organized sports? (List)

What is your current workout regimen? (List Routine)

Are you comfortable in the water for extended periods of time? _______ If so, can you swim 500 yards utilizing only the sidestroke, breaststroke or freestyle? _______ In what time? ________

Given two minutes for each exercise, what is the maximum numbers of each of the following exercises you are able to perform? Pushups_______ Sit-ups______ Dead Hang Pull-ups______

Can you run continuously for 1.5 miles? _______ If so, in what time? ____:____

To be filled out by scout or recruiter:

AFQT: ________

SEAL: GS____+MC____+EI____=_____ (170) OR VE____+MK____+MC____+CS_____=_____ (220) OR VE+AR=_______ (110) AND MC=50

SWCC: AR____+VE____=_____ (103) AND MC=51

EOD: VE____+AR____=____ (109) AND MC=51 OR GS____+MC____+EI____=_____ (169)

ND: VE____+AR____=_____ (103) AND MC=51

AIRR: VE____+AR____+MK____+MC____=____ (210) OR VE____+AR____+MK____+AS____=_____ (210)

Future Sailor has been screened to meet selected program eligibility requirements.

NRS____________________ RECRUITER NAME__________________________________

PHONE__________________ Recruiter Signature_____________________________________

MENTOR NAME:_Mr. Dan Ploussard_______ NUMBER: 651.587.6053______

CORRDINATORNAME: SOCS Lundquist NUMBER: 757.277.1807______

I have been fully briefed and understand the challenges that I face if granted a contract through the Warrior Challenge program and am fully committed to the program.

Candidate signature_________________________________ Date______________

PLEASE INCLUDE THIS COMPLETED FORM IN KIT FOR APPROVAL

NOTE:

THIS IS NOT A PROGRAM GUARANTEE, only a questionnaire to help determine program eligibility and interest.