ADD A RECRUIT TO THE DATABASE

(*) REQUIRED FIELD
 
*First Name: 
M: *Last:
WALETA NUMBER YY-00-##: 
DISPLAY ON AGENCY PAGE? YES  NO 
 
Agency: 
 
Weekly Info: 
Class Size: 
 
Weekly Academic Score: 
    Academic Average:      Academic Rank: 
POPAT: 
    POPAT Average:      POPAT Rank: 
FIT FORCE : 
    FIT FORCE Average:      FIT FORCE Rank: 
OVERALL PHYSICAL RANK: 
 
RTO Notes: 

PERSONAL INFORMATION

SSN: 
    D.O.B.: 
Photo File: 
 
Address 1: 
 
Address 2: 
 
City: 
    St:     Zip: 
Phone: 
 
Cellphone: 
 
Email: 
 

MEDICAL INFORMATION

Drug Allergies: 
 
Current Meds: 
 
Special Medical: 
 
Blood Type: 
 

EMERGENCY CONTACT INFORMATION

Emergency Name: 
 
Emergency Work: 
 
Emergency Work Addr: 
 
Emergency Work Phone: 
 
Emergency Home Phone: 
 
Emergency Cell Phone: 
 
Relationship: 
 
Emergency Home Address: 
 

NOTES & COMMENTS

Notes: