ARIZONA NATIONAL GUARD
AGR APPLICATION SUPPLEMENT
PERSONAL BACKGROUND QUESTIONNAIRE (All applicants must complete)
1. Have you ever been convicted of a law violation other than a minor traffic violation?
NO YES If yes, please explain on reverse.
2. Are you a current member of the National Guard? NO YES
State: Army or Air Guard: Unit:
3. Have you performed any periods of AGR service? NO YES
From Date: To Date: Reason for Separation (if applicable):
4. CURRENT MEMBERS OF THE US ARMY (Including National Guard and Reserves) ONLY.
All other applicants, go to question 5.
I certify the following: (Any items not completed will be explained on the reverse)
a. My current official height and weight is inches, and pounds.
b. I meet the body fat measurement requirements outlined IAW AR 600-9: YES NO
c. I last took the Army Physical Fitness Test on (date) .
d. My most current physical is dated: .
My physical profile is rated: ( ) ( ) ( ) ( ) ( ) ( ) .
5. CURRENT MEMBERS OF THE US AIR FORCE (Including National Guard and Reserves) ONLY.
All other applicants, go to question 6.
Date _______________ & Score _______________ of last Air Force Physical Fitness Test.
6. Have you ever received severance pay from the Armed Forces? NO YES
If yes, please explain on reverse.
CERTIFICATION AND AUTHORITY FOR RELEASE OF INFORMATION
In order to verify the responses to the above statements, I hereby consent to the release of information by agencies and
individuals who possess the applicable information. I also understand that a false answer on this application may be
grounds for not being employed or for being terminated after I begin work. I certify that the information given above is
true and complete to the best of my knowledge and belief, and is given in good faith.
Your Signature (ink only)
TELEPHONE #: HOME: ( ) WORK: ( ) DSN:
NAME (LAST, FIRST MI) AGR ANNOUNCEMENT NUMBER & TITLE
AZ FORM 34-1, 22 Jun 04 (Supersedes 13 Feb 98)
