14R1306-ISOPREP.pdf

ISOPREP Worksheet

SECTION 1 – Personal Information

LAST name:

FIRST name:

MIDDLE Initial:

GO BY NAME (or nickname):

GENDER (Male of Female):

PAYGRADE:

FULL SSN (000-00-0000):

DOB: (yyyy/mm/dd):

SERVICE Branch:

CURRENT UNIT:

BLOOD TYPE:

HEIGHT:

WEIGHT:

HAIR COLOR:

EYE COLOR:

ETHNIC GROUP:

CITIZENSHIP (Primary):

CITIZENSHIP (Secondary):

CITIZENSHIP (Other): _________

ACCENT:

RELIGIOUS PREFERENCE:

IDENTIFYING SCARS/MARKS/TATTOOS:

KNOWN MEDICAL CONDITIONS AND PERSCRIPTIONS:

SECTION 2 – Uniform Data

SHIRT SIZE (XS, S, M, L, XL):

PANTS SIZE (XS, S, M, L, XL):

HAT SIZE (XS, S, M, L, XL):

BOOT TYPE (Men or Women):

BOOT SIZE:

BOOT WIDTH:

SECTION 3 – Training / Capability Data

SERE 100 CODE OF CONDUCT LEVEL B TRAINING:

COMPLETION DATE (Month and Year):

METHOD OF COMPLETION (Online or Other):

If other, describe:

LANGUAGE CAPABILITY (primary):

LANGUAGE CAPABILITY (other):

READ Other Language Capability (Excellent, Good, or Poor):

WRITE Other Language Capability (Excellent, Good, or Poor):

SPEAK Other Language Capability (Excellent, Good, or Poor):

COMMENTS:

ANY OTHER LANGUAGE CAPABILITIES (describe):

SECTION 4 – Reintegration Information

PRIMARY NEXT OF KIN

NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

TELEPHONE:

IS PRIMARY NEXT OF KIN SAME AS PARENT NO. 1 OR NO. 2? IF YES

PARENT NO. 1 (optional for contractors)

NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PARENT NO. 2 (optional for contractors)

ADDRESS:

CITY:

STATE:

CHILDREN LIVING AT HOME

DOB:

NAME:

DOB:

NAME:

DOB:

DOB:

HOME OF RECORD (optional for contractors)

ADDRESS:

CITY:

STATE:

SPECIAL FAMILY SITUATIONS

DESCRIBE:

STOP!

DO NOT FILL OUT IF YOU ARE NOT ON A SIPR CLASSIFIED ACCOUNT

Personal Authentication Information – Four Statements

IF FILLING OUT THE BELOW REQUESTED INFORMATION, STOP HERE AND

MOVE THIS DOCUMENT TO THE SIPR/SECURE NETWORK. DO NOT TRANSMIT

VIA NIPR/UNCLASSIFIED E-MAIL OR FILL OUT ON A NIPR/UNCLASSIFIED

TERMINAL/COMPUTER OR OTHER MEANS.

THIS DOCUMENT BECOMES CLASSIFIED CONFIDENTIAL ONCE THE

FOUR STATEMENTS AND AUTHENTICATION NUMBER REQUESTED BELOW

ARE PROVIDED.

HANDLE ACCORDINGLY.

INSTRUCTIONS:

PROVIDE 4 SEPARATE STATEMENTS IN WHICH FOUR QUESTIONS CAN BE

DERIVED FROM EACH ONE. THE STATEMENTS SHOULD BE SOMETHING

THAT YOU CAN REMEMBER UNDER DURESS. DO NOT STATE THINGS THAT

ARE A MATTER OF PUBLIC RECORD. USE FAVORITES, FIRSTS, HOBBIES, ETC.,

ETC.

EXAMPLE STATEMENT:

MY FIRST CAR WAS A BLUE 1972 AMC JAVALIN.

FROM THIS ONE EXAMPLE STATEMENT, I COULD ASK FOUR QUESTIONS AND

GET FOUR ANSWERS:

1. WHAT COLOR WAS YOUR FIRST CAR – BLUE

2. WHAT YEAR WAS YOUR FIRST CAR – 1972

3. WHAT MAKE WAS YOUR FIRST CAR – AMC

4. WHAT MODEL WAS YOUR FIRST CAR – JAVALIN

PROVIDE FOUR STATEMENTS BELOW BASED ON THE EXAMPLE STATEMENT

ABOVE. Here are some sample topics that might work for you.

STATEMENT #1: My four favorite foods are

STATEMENT #2: My four favorite hobbies are

STATEMENT #3: My first car was a

STATEMENT #4: My four favorite sports teams are

PERSONAL AUTHENTICATION NUMBER

Must be four digits, no repeating numbers, no zeros, not public record.

Example: 1957

For assistance in filling-out your ISOPREP and the initial required verification and subsequent semi-annual periodic annual reviews, contact your Command ISOPREP Unit

Manager.