Fill and Sign the Sa Army Application Forms 20162017

ALCOHOLIC INFLUENCE REPORT INSTALLATION VIOLATION REPORT NO. ACCIDENT REPORT NO. DATE, TIME AND LOCATION OF ACCIDENT OR INCIDENT DATE AND TIME IN CUSTODY APPREHENDING OFFICER NAME OF SUBJECT GRADE/CATEGORY SSN UNIT OF ASSIGNMENT/ADDRESS DRIVER AGE SEX Male APPROX. WEIGHT PASSENGER OPERATOR'S LICENSE NO. PEDESTRIAN STATE Female Check all applicable boxes describing conditions observed, i.e., more than one box may be checked to describe conditions observed. SECTION I - OBSERVATIONS MADE BY (Name, grade, SSN & organization) WITNESSED BY (Name, grade, SSN & organization) HAT OR CAP JACKET OR COAT CLOTHES (Describe type & color) SHIRT OR DRESS PANTS OR SKIRT CONDITION Soiled BREATH ATTITUDE Disorderly Mussed DESCRIBE Disarranged Orderly ODOR OF ALCOHOLIC BEVERAGE Strong Moderate Faint None Excited Hilarious Carefree Sleepy Profanity Talkative Combative Indifferent Insulting Cocky Cooperative UNUSUAL ACTIONS Hiccoughing Belching Vomiting Not understandable Mumbled Thick Tongued Stuttered SPONTANEOUS ACTS (Statements, walking, turning, etc.) Slurred Accent SPEECH INDICATE BRIEFLY WHAT FIRST LED YOU TO SUSPECT ALCOHOLIC INFLUENCE Fighting Polite Crying Mush Mouthed Fair Laughing Confused Good SIGNS OR COMPLAINT OF ILLNESS OR INJURY SECTION II - PERFORMANCE TESTS (Warning of rights in accordance with separate departmental policy is required for military personnel) ADMINISTERED BY (Name, grade, SSN & organization) DATE & TIME TESTS PERFORMED BALANCE WALKING TURNING FINGER TO NOSE COINS Needed Support Falling Falling Staggering Staggering Falling RIGHT Hesitant Unable Other Stumbling Hesitant Fumbling Slow Swaying Swaying Hesitant Sure Unsure Swaying LEFT Completely missed Sure ABILITY TO UNDERSTAND INSTRUCTIONS Fair Good Poor REMARKS DD Form 1920, AUG 73 Wobbling Unsure Unsure Sure Sure Sure Completely missed Sure BALANCE DURING COIN TEST EFFECTS OF ALCOHOL Extreme None ABILITY TO DRIVE Unfit Obvious Fit Slight Reset SECTION III - INTERVIEW (Warning of rights in accordance with separate departmental policy is required for all personnel) Where were you going? Were you operating a vehicle? What street or highway were you on? Direction of travel? Where did you start from? What time did you start? What city (county) are you in now? What is the date? INTERVIEWER TO FILL IN ACTUAL TIME DAY DATE When did you last eat? What time is it now? What day of the week is it? INTERVIEWER'S NAME What did you eat? What were you doing during the last three hours? Have you been drinking? What? How much? Time started? Time stopped? Where? Are you under the influence of an alcoholic beverage now? What is your occupation? When did you last work? Do you have any physical defects? If so, what's wrong? Do you limp? Have you been injured lately? Are you ill? If so, what's wrong? If so, what's wrong? Did you get a bump on the head? Were you involved in an accident today? If so, what? Where? Have you seen a doctor or dentist lately? How much? When? If so, who? What for? When? Are you taking tranquilizers, pills or medicines of any kind? If so, what kind? (Get sample) Do you take insulin? Have you had any alcoholic beverage since the accident? Last dose? If so, last dose? Do you have epilepsy? Have you had any injections of any other drugs recently? If so, what for? What kind of drug? When did you last sleep? Diabetes? How much sleep did you have? Last dose? Are you wearing false teeth? Glass eye? HANDWRITING SPECIMEN (Signature and/or anything he chooses) TYPE OF SPECIMEN Blood Breath Saliva SECTION IV - CHEMICAL TEST DATA TIME, DATE AND LOCATION OF TEST Urine Other ADMINISTERED BY (Name, grade, SSN & organization) TEST RESULT IF TEST REFUSED, OR UNABLE TO BE ADMINISTERED, STATE REASON TYPE COVERAGE Video tape SECTION V - VIDEO TAPE, MOTION PICTURE, VOICE RECORDINGS SCOPE OF COVERAGE Motion Picture Voice Observation Performance test TAKEN BY (Name, grade, SSN & organization) NAME Interview REFERENCE CODE SECTION VI - SUPPLEMENTARY DATA ADDRESS TELEPHONE NO. CONDITION WITNESSES PASSENGERS IN SUSPECT'S VEHICLE DD Form 1920 Reverse, AUG 73 Reset