Alterations to this checklist are not authorized
ACTIVE/RESERVE MEDICAL SERVICE CORPS (MSC) OFFICER APPLICATION CHECKLIST
MSC Direct 2300 / MSC Recall 23001 / MSC HSCP 23007 / MSC HPSP 1995 / Reserve 2305
ATTENTION All NAVCRUITDISTs: Documents should be attached in CIRIMS per the CIRIMS User Guide.
NAME:
NAVCRUITDIST PROC:
OQPI YES
DESIGNATOR:
NAVCRUITDIST:
N/A
001
106
107
023
002
015
004
006
008
018
103
019
020
117
104
121
125
126
009
012
024
123
013
011
010
005
021
016
105
022
SECTION 1: PROGRAM DOCUMENTS
Scroll Pre-Screening Form (NC 1131/67) submitted to NAVCRUITCOM via OPO
Personal and Professional Information Sheet required for 2300, 2305, 23001 only. Podiatrist, Optometrist,
Audiologist, Physician Assistant, Clinical Psychologist, Pharmacist, Dietician, Social Worker, Physical Therapist,
Occupational Therapist (Note 106)
Submit to Centralized Credentials and Privileging Department, Jacksonville, FL (CCPD-JAX) All specialties that
are health care providers and hold a state license(s). (CCPD-JAX checklist available on N34 website) (Podiatrist,
Optometrist, Audiologist, Physician Assistant, Clinical Psychologist, Pharmacist, Dietician, Social Worker, Physical
Therapist, Occupational Therapist) (Note 107)
SECTION 2: BASIC APPLICATION
Application Checklist
Application Processing and Summary Record (NC 1131/238)
EPSQ (SF 86) signed and dated by applicant within past 6 months (Refer to COMNAVCRUITCOM NOTE 5510).
Submit to OPM at time of Physical. (Note 015)
Birth Certificate or
Request Verification of Birth (DD Form 372) if original birth certificate unavailable
Evidence of Citizenship Form (NC 1100/25) if naturalized
Social Security Card Issued by Social Security Administration (SSA) or DD Form 214 or Report of Separation and
Record of Service for Prior Army or Air National Guard Members (NGB Form 22) (Note 008)
SECTION 3: PERSONAL INFORMATION
Resume / Curriculum Vitae signed and dated by applicant
Professional Community Interviewer’s Appraisal Sheet (NC 1131/5) (Note 103)
Employment References DD Form 370, front and back pages. Minimum of three references are required. Submit
DD 370 from each employer for the last three years. Character reference(s) required when employer references are
not available. The Commanding Officer shall be requested to provide a DD 370 for all applicants who are serving on
active or inactive duty in all branches.
Character References required if employment references are not available. (only upon PM approval and notation on
Form DD370)
Instructor Reference 2300, 23007 and 2305 include if applying for student programs and if employment references
are not applicable. College Committee letters accepted.
Licensure Verification for Medical Program Applicants (NAVPERS 1300/4) and Copy of Current License for all
states ever licensed for all clinical specialties requiring licensing ( Podiatrist, Optometrist, Audiologist, Physician
Assistant, Clinical Psychologist, Pharmacist, Dietician, Social Worker, Physical Therapist, Occupational Therapist)
Duty Preference for Medical Programs (NC 1131/16) all DIRECT programs, three choices required. Ensure
applicant and recruiter contact information is accurate and current.
Application Letter for Medical Service Corps Accession Bonus if applicable (A declination letter is required if the
applicant does not want the authorized bonus)
Application for HPLRP if eligible (A declination letter is required if the applicant does not want the LRP)
SECTION 4: PRIOR SERVICE INFORMATION
DD 214(s) If prior active service/reserve service (note member’s copy page 4)
Conditional Release (DD 368) Navy Drilling Reserve, IRR and all non-Navy military
CO’s Recommendation all Active Duty applicants
Enlisted Personnel Action Request (NP 1306/7) active duty Navy enlisted only. (Note 123)
Contingent Resignation Letter if prior or currently commissioned (approval letter required to final selection)
Statement of Service for prior Commissioned Officers
Prior Service Record If prior service; send only fitreps/evals, pgs 4, 5, 9, and any derogatory information (Note 010)
SECTION 5: MISCELLANEOUS DOCUMENTS
Change of Name Statement (NC 1131/14) and provide copy of court documents/marriage license
Family Care Plan Certificate (NP 1740/6) must include if single parent or dual military as applicable
Police Record Checks (DD 369) Submit if any derogatory information noted on application
Maximum Age Statement of Understanding (NC 1131/54)
United States Navy Tattoo Screening Certificate (NC 1130/104)
For Official Use Only When Filled-In
Rev 5/28/2013
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Alterations to this checklist are not authorized
026
007
014
017
180
Tattoo/Body Art/Mutilation/Body Marking Warning (NAVPERS 1070/613)
Disclosure of SSN Privacy Act Statement (NC 5211/1)
Statement of Understanding for Security Investigation (NC 1070/613)
Fingerprint Charts (FD258) Retain at NRD.
Commitment To Success Statement of Understanding (NC 1131/15)
SECTION 6: ACADEMIC INFORMATION
Copies of Official Transcripts include all front and reverse sides for each college attended (Note 003)
Academic Degree Completion Plan (NC 1131/4) Include for HSCP, HPSP, and DIRECTs (within 6 months prior to
graduation). Ensure total hours blocks and required hours blocks completed, applicant is enrolled full time Spring and
Fall if applying for HSCP/HPSP and signed by Dean/advisor. 2300, 2305 submitting kits anticipating graduation.
Academic Year Statement 1995 PA. Not required for kit submission but required before FINSEL. NRD must submit
to NMPT&E with signed Commissioning Documents (Oath of Office & Service Agreement)
http://navmedmpte.med.navy.mil/accessions/index.cfm
GPA Calculation Worksheet (NC 1131/53) include all schools attended for student programs. Only qualifying
degree required for Direct Accession (DA) and Direct Commission Officers (DCO) who have already graduated. Not
required for DA or DCO with at least three years experience in respective subspecialty.
Professional School/Residency Entrance Exam Report (OAT scores for Optometry HPSP 1995)
003
101
113
102
114
115
116
Letter of Acceptance to School/Residency all HSCP and HPSP students not yet attending school/residency.
Letter of Good Standing with School/ Residency Include for HSCP and HPSP if currently enrolled and if applying
for DIRECT within 6 months prior to graduation. Letter must include projected graduation date. Not required for
Clinical Psychology Internship applicants. (LOGS will be acceptable in place of a LOA for someone already in
school/residency)
GRE or GMAT Score. HSCP for HCA require GRE score of (1050 old GRE version or 303 new GRE version) or
a GMAT score of 525 to apply.
SECTION 7: RECALL (Note: Not eligible if FOS x2)
Application for Recall to Ext Active Duty (NP 1331/5) prior commission any service (note fail to selects)
PRIMS Report
Annual Statement of Service History (ASOSH) - Point Capture
Last 4 FITREPs (dependent upon length of service)
SECTION 9: WAIVERS
All required NRC Mandatory Determinations completed and attached.
All required CO NRD Alcohol/Drug/Civil Waivers approved and attached.
All required NRC Alcohol/Drug/Civil Waivers approved and attached.
Required RE-code waiver approved and attached.
128
108
110
111
112
900
910
920
930
Printed Name of Person Completing
Checklist
Signature/Date of Person Completing
Checklist
R-OPS/AR-OPS Signature/Date
Notes:
003
Transcripts can be electronic version but must be printed in the Recruiter’s presence and signed/dated by an Officer Recruiter (in
rank of 01 or above) to be a true copy. If classes taken at a prior school are listed with class name and grade on degree transcript
applicant does not need to request that transcript. Cannot just state number or credits/hours transferred. Transcripts obtained
online must be official transcripts.
008
Copies should be "Certified as a True Copy" to ensure that the original was cited and "Reproduced for Reference Purposes Only"
written or typed in a conspicuous location.
010
Any derogatory information requires a clarifying statement on the Application Processing & Summary Record (APSR).
015
If applicant has a current NACLC (<10 yrs old) or SSBI (<5 yrs old) in JPAS, with no break in service >2 yrs, a new SF-86 must be
completed. Include a copy of the new SF-86 and JCAVS Personal Summary Page with the completed application. Note: The SF-86
will not be transmitted to OPM in NASIS unless requested from higher authority. If applicant had a >2 year break in federal service
since adjudication of their NACLC or SSBI, a new SF-86 must be submitted to OPM via EQIP.
103
At least one (1) interview must be by an active duty officer in same subspecialty for which applying; second interview may be from
any Naval officer (active, reserve or retired). Interviews cannot be from anyone in recruiting and at least one must be in person.
Required O-4 or above interviewer unless otherwise negotiated with Specialty Leader/Program Manager. Annotate on NC1131/1 if
negotiation made with SL/PM. Note: Clinical Psychology Intern and USUHS: Recruiters must schedule interviews directly with Naval
For Official Use Only When Filled-In
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Alterations to this checklist are not authorized
Medical Center San Diego & National Naval Medical Center Bethesda Training Directors. Annotate on NC 1131/1 the date of
proposed interviews if unable to complete prior to kit submission. Recommend applicant obtain phone interview with Training
Director from other MTF that they are not interviewing in person. This is not required but suggested.
106
The two peer references in the CCPD credentialing package counts as two of the three references required for the kit
submission. A copy of these must be placed within the application with the other references.
107
Pending graduates do not need CCPD; however, new graduates need CCPD.
123
Active duty applicants applying for program must submit an NP1306, including message release from NPC (requesting conditional
release). Once applicant is final selected, NRD must submit an NP1306 requesting discharge or release from active duty.
For Official Use Only When Filled-In
Rev 5/28/2013
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