united states navy tattoo screening certificate

UNITED STATES NAVY TATTOO SCREENING CERTIFICATE
COMNAVCRUITCOMINST 1130.8 and 1131.2
NAME (Last, First, Middle, Jr., etc.)
Date:
YES
NO
N/A
1. Does the applicant/candidate have any tattoos/body art/branding?
2. Does the applicant/candidate have any tattoo/body art/brand visible behind the ears or on the neck
3. Has the applicant/candidate ever had any tattoo, body art or brand removed or covered?
Any "Yes" response above requires an enlistment eligibility determination by the NAVCRUITDIST CO (May be delegated to XO, ROPS, CMC, CR, or EPDS when authorized "by direction" authority by the CO).
YES
NO
N/A
4. Are any of the tattoos/body art/brands on the face (excluding cosmetic tattoos) or scalp?
5. Is there one or more tattoos larger than one inch on the neck or behind the ears, visible above the collar of a
properly fitted crew neck t-shirt? (Excluding cosmetic tattoos)
6. If applicable, are cosmetic tattoos applied in good taste with natural color enhancement and of a
conservative nature?
7. Are any of the tattoos/body art/branding representative of gang membership, advocate racial, ethnic,
racial discrimination, sexism (including expressions of nudity), drug related, obscene, or are prejudicial to
good order, discipline, and morale, or are of a nature to bring discredit upon the Navy?
8. Are any of the tattoos a result of a specific activity? (i.e., specifically an illegal activity or as a result of any
violation of law (s))
Any "Yes" response to items 4, 5, 7, or 8 above is disqualifying, not authorized for Enlistment. Any "No" response to
Item 6 is disqualifying, not authorized for Enlistment.
NOTE: All questionable body markings, due to content, size, number, and/or location, shall be forwarded to NAVCRUITCOM for eligibility
determination.
Applicant Signature
Date
Recruiter Signature
Date
Describe all tattoos, brands, and/or body ornamentation (if applicable) on following page.
Explain tattoo, brand, and/or body ornamentation removal process, if applicable.
CO/XO/R-OPS/CMC/CR/EPDS Reviewing Comments:
APPROVED
DISAPPROVED
CO/XO/R-OPS/CMC/CR/EPDS Signature
NAVCRUIT 1130/104
(Rev 05-2016)
Typed Name/Title:
For Official Use Only - Privacy Sensitive
Date:
Page 1 0f 2
UNITED STATES NAVY TATTOO SCREENING CERTIFICATE
Documentation.
The following depicts the location and description of the applicant's
body markings.
Place number on body location and describe in corresponding blocks below
indicating content and size in inches (not required if no Tattoos):
FRONT VIEW
BACK VIEW
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
6.
6.
7.
7.
8.
8.
9.
9.
10.
10.
Part V. Certification.
I certify above body marking information is accurate.
(Name of Applicant)
(Name of Recruiting Rep)
NAVCRUIT 1130/104 (Rev 05/2016)
(Signature of Applicant)
(Signature of Recruiting Rep)
(Date)
(Date)
Page 2 of 2
ADMINISTRATIVE REMARKS
NAVPERS 1070/613 (REV. 08-2012)
PREVIOUS EDITIONS ARE OBSOLETE
SUPPORTING DIRECTIVE MILPERSMAN 1070-320
SHIP OR STATION:
SUBJECT:
TATTOO/BODY ART/BODY MUTILATION/
BODY MARKING WARNING
PERMANENT
TEMPORARY
AUTHORITY (IF PERMANENT):
COMNAVCRUITCOMINST 1131.2 Chapter 2
: I understand the Navy’s Policy on Tattoo/Body Art/Body Mutilation and Body Markings. I
further understand that I am not to obtain or have any additional tattoos, body art, body
mutilation, body markings applied to my body while school or awaiting commissioning.
Failure to comply with this warning could result in my release from all commissioning
programs.
__________________________
(Applicant Signature)
_____________________________
(Witness Signature)
(Commissioned Officer or By Direction)
PRIVACY ACT NOTIFICATION
This document contains information covered under the Privacy Act of 1974, 5 USC 552a and its various implementing regulations
and must be protected in accordance with those provisions. You, the recipient/user, are obliged to maintain it in a safe, secure
and confidential manner. Re-disclosure without consent or as permitted by law is prohibited. Unauthorized re-disclosure or failure
to maintain confidentiality subjects you to application of appropriate sanctions. If you have received this correspondence in error,
please notify the sender immediately and destroy any copies you have made.
FOR OFFICIAL USE ONLY WHEN FILLED IN
ENTERED AND VERIFIED IN ELECTRONIC SERVICE RECORD:
VERIFYING OFFICIAL RANK OR GRADE/TITLE:
NAME (LAST, FIRST, MIDDLE):
DATE:
SIGNATURE OF VERIFYING OFFICIAL:
SOCIAL SECURITY NUMBER:
FOR OFFICIAL USE ONLY
PRIVACY SENSITIVE
BRANCH AND CLASS:
USN
DISCLOSURE OF SOCIAL SECURITY NUMBER
Privacy Act Statement
1. Disclosure of your social security number is necessary in
determining your eligibility for enlistment in the Armed Forces of the
United States. This number is required on all application forms,
where indicated.
2. The authority for requesting your social security number is
contained in Section 301, Title 5, United States Code/Bureau of Naval
Personnel Manual, Article 1000-060, which established departmental
regulations for personnel administration.
3. Your social security number will be used as a unique identifier
for all documents which are part of your application file. The number
will be used for purposes of record checks with local, state and
federal law enforcement agencies, for investigatory purposes in
determining eligibility for security clearance, and for verification
of status with the Selective Service Commission. If your application
is accepted and you are enlisted or appointed in the United States
Navy or Naval Reserve, your social security number will become your
service number for all record purposes.
4. Your social security number is FOR OFFICIAL USE ONLY and will be
used in strict confidence in accordance with Federal law and
regulations.
I have read and understand the foregoing statement.
Typed Name of Applicant
Signature of Applicant
Date Signed
Typed Name of Witness
Signature of Witness
Date Signed
FOR OFFICIAL USE ONLY
NAVCRUIT 5211/1 (Rev 10-2010)
COMMITMENT TO SUCCESS
Per COMNAVCRUITCOMINST 1131.2, Chapters 4, the contact is required to complete this form during initial processing. Then, if applicable in Chapter 8, have
the Enlistee/Officer complete this form during the 72 Hour Indoctrination. Once the form is completed during the 72 Hour Indoctrination, upload a signed copy into
CIRIMS and retain the original in the collegiate/officer candidate's residual folder.
SECTION I (Must be completed by all applicants.)
Naval Officer Delayed Entry Program (DEP) Guide to Success
I have received and reviewed the Naval Officer Delayed Entry Program Guide to Success. I have been encouraged to review the Personnel
Qualification Standards (PQS) to help me prepare for my transition to OCS/ODS.
Navy's "Zero Tolerance" Drug Policy
I have been informed about the Navy's "Zero Tolerance" drug policy. If I am an active duty collegiate, I also understand I will be required to participate
in the Navy Recruiting District's Command Urinalysis Program.
Physical Fitness
The Navy considers a physically fit body as important as a sound mind. The objective of the physical training classes at Officer Training Command
Newport (OTCN) are to develop strength, endurance and to improve your overall physical condition so you can meet demanding physical fitness
requirements. Physical training instruction begins immediately upon arrival. You are required to be within navy body fat standards per OPNAVINST
6110.1 upon arrival. Within the first two days of training, you will be weighed and measured and you must pass a Physical Fitness Assessment with a
minimum score of "satisfactory" per the Navy Physical Readiness Program Instruction (OPNAVINST 6110.1). You should complete the Navy PreEntry Physical Training Program at http://www.navy-prt.com/pre-conditioning.pdf or an equivalent program prior to reporting.
SECTION II (Must be completed by OCS candidates only.)
"Faces of OCS" video
I have viewed the video "Faces of OCS." I understand that Officer Candidate School is a physically and mentally challenging program and I am
prepared for the rigors of this training. The "Faces of OCS" video is available for viewing at http://www.ocs.navy.mil/OCS video.asp.
OCS Website
I have accessed the OCS website at http://www.ocs.navy.mil/ and reviewed its contents.
Pre-OCS Physical Fitness Training Guide
I have received a copy of the "Pre-OCS Physical Fitness Training Guide" and was informed of the physical fitness requirements listed in OPNAVINST
6110.1. I have also been informed that I will have to pass, at a minimum, the third class swim test once I arrive at OCS.
OCS Physical Fitness
During your first week of training you will commence a regimen of daily physical training. You must be able to perform aerobic activity, muscular
strength exercises and endurance exercises. Aerobic activity will include running approximately three miles three or four times per week, primarily on
track or road surfaces. The level of strength and endurance necessary to successfully complete Officer Candidate School (OCS) is similar to the level
required in cross-training fitness programs as seen on infomercials. You will benefit greatly if you report to OCS in good physical condition.
SECTION III (Must be completed by ODS candidates only.)
ODS Website
I have accessed the ODS website at http://www.ocs.navy.mil/ and reviewed its contents.
ODS Physical Fitness
Physical training will include two or three days of strength and conditioning exercises to include pushups, sit-ups, and various other exercises.
Students will run three to four days per week. Run days will consist of cone drills, sprints and sustained runs. You will be required to compete
three Physical Readiness Tests (PRT's) (an in PRT, Mid PRT, and out PRT) while assigned to ODS.
Typed or Printed Name of Applicant
Signature of Applicant / Date
(Required at time of initial processing)
Signature of Witness / Date
Typed or Printed Name of Witness
(Initial Processing)
Signature of Applicant / Date
(Required at 72 Hour Indoctrination)
Signature of Witness / Date
Typed or Printed Name of Witness
(Required at 72 Hour Indoctrination)
NAVCRUIT 1131/15 (Rev 02-2016)
FOR OFFICIAL USE ONLY
ADMINISTRATIVE REMARKS
NAVPERS 1070/613 (REV. 08-2012)
PREVIOUS EDITIONS ARE OBSOLETE
SUPPORTING DIRECTIVE MILPERSMAN 1070-320
SHIP OR STATION:
SUBJECT:
STATEMENT OF UNDERSTANDING FOR
SECURITY INVESTIGATION
PERMANENT
TEMPORARY
AUTHORITY (IF PERMANENT):
COMNAVCRUITCOMINST 1131.2 SERIES
: If selected, I understand that my appointment as a commissioned officer in the United
States Navy/Navy Reserve is being accomplished prior to completion of a required security
investigation and issuance of a Top Secret/Secret security clearance. I further understand
that if as a result of the post-commissioning investigative processes, I am determined to be
unacceptable for appointment as a commissioned officer; I will be subject to discharge from
the United States Navy/Navy Reserve.
__________________________
(Applicant Signature)
_____________________________
(Witness Signature)
(Commissioned Officer or By Direction)
PRIVACY ACT NOTIFICATION
This document contains information covered under the Privacy Act of 1974, 5 USC 552a and its various implementing regulations
and must be protected in accordance with those provisions. You, the recipient/user, are obliged to maintain it in a safe, secure
and confidential manner. Re-disclosure without consent or as permitted by law is prohibited. Unauthorized re-disclosure or failure
to maintain confidentiality subjects you to application of appropriate sanctions. If you have received this correspondence in error,
please notify the sender immediately and destroy any copies you have made.
FOR OFFICIAL USE ONLY WHEN FILLED IN
ENTERED AND VERIFIED IN ELECTRONIC SERVICE RECORD:
VERIFYING OFFICIAL RANK OR GRADE/TITLE:
NAME (LAST, FIRST, MIDDLE):
DATE:
SIGNATURE OF VERIFYING OFFICIAL:
SOCIAL SECURITY NUMBER:
FOR OFFICIAL USE ONLY
PRIVACY SENSITIVE
BRANCH AND CLASS:
USN