Active Duty Application Step 1/5: Personal Info Leave this field blank First Name Last Name Your Email List three career field you are interested Separate by comma How did you hear about us? Social MediaFriendinternet surfingcolleague Date of Birth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day12345678910111213141516171819202122232425262728293031 Year1923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043 Photo Upload (optional) Choose fileUploading… (0%) Browse A file with this name has already been uploaded. This file type isn’t allowed. This file size is too big. Gender ManWomanotherPrefer not to disclose Racial Group Asian/Pacific Islander Black or African American Hispanic Native American White Other Prefer Not to Disclose Phone (Mobile) Can we text you? Yes, text me. No, thanks. Phone (Home) (optional) If you have a LinkedIn profile, include its URL here. (optional) Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Current Duty Station In which military branch did you serve/are you serving? US Air ForceUS Air Force ReserveUS Air National GuardUS ArmyUS National GuardUS Army ReserveUS Coast GuardUS Coast Guard ReserveUS Marine CorpsUS Marine Corps ReserveUS NavyUS Navy ReserveUS Space Force What is the last pay grade you held in the military? E-1E-2E-3E-4E-5E-6E-7E-8E-9O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10W-1W-2W-3W-4W-5 What is the most recent year during which you served on active duty? Did you receive an honorable discharge from your military service? Yes No I am currently serving Please provide a detailed explanation, including the type of discharge received. Have you been convicted of any felony or are you currently under indictment? Yes No If you answered, "Yes" to the previous question, please provide a detailed explanation. Have you received visible or invisible wounds during your military service? Yes No Please check which categories apply to your service-connected disability. Visible Invisible Please tell us more about your time in service. What is the highest level of education that you have completed? High School/DiplomaCollegeAssociate DegreeTechnical DegreeBachelor's DegreeGraduate DegreeOther What is your current employment status? Active Duty Military Military Reserves Full-Time Employment (civilian) Part-Time Employment (civilian) Student Currently Not Employed What are your career aspirations? Please provide a short introduction paragraph to be shared with your Mentor. Which of the following do you hope to accomplish in the next year? Start/expand a small business Obtain employment Develop a professional skill set Pursue further education Advance in a current career About which of the following preferences do you feel most strongly? My Mentor is of the same gender. My Mentor shares my ethnic background. I have no preference. What are your favorite recreational activities? Attend cultural events Attend religious services Entertain in my home Go out to bars or restaurants Participate in sports and fitness Spend time outdoors Volunteer None / No Preference What are your LEAST favorite recreational activities? Attend cultural events Attend religious services Entertain in my home Go out to bars or restaurants Participate in sports and fitness Spend time outdoors Volunteer None / No Preference Does AHC have your permission to share your image, and quote you on our social media platforms, in our emails and newsletters, and in our presentations? * Yes No Yes, I am agree terms and conditions by AHC Continue
