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FOR OFFICIAL USE ONLY MARINE HELICOPTER SQUADRON ONE APPLICANT SCREENING/INTERVIEW FORM LAST NAME RANK FIRST NAME SSN DOB MOS POB Date of Birth MI CITIZENSHIP Place of Birth TIME ON STATION UNIT THE BELOW INFORMATION IS FOR SECURITY ADMINISTRATION ONLY PSD RECOMMENDED YES / NO GREENSIDE ONLY YES / NO CLEOC FORWARD TO S-2 YES / NO CREDIT FORWARD TO MEDICAL YES / NO 50 STATE DATE PULLED / SIGNATURE PRIVACY ACT OF 1974 ADVISEMENT STATEMENT The authority for requesting the following information...
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Information such as the name and contact details of the individual or business, details about the proposed headquarters location, information about the nature of the business or activities to be carried out at the headquarters, and any other relevant information.
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