quick response security training (qrst) - Ohio Military Reserve

4. MEDICAL HISTORY:1. Do you have any medical condition or handicap which will prevent you fromsuccessfully participating in the training prescribed for QRST?2. Do you have any medical condition or handicap which may be made worseby your participation in the training prescribed for QRST?Yes ____ No ____Yes ____ No ____3. Are you currently taking any prescribed medication(s)? Yes ____ No ____4. Are you under a doctor’s care? Yes ____ No ____5. Do you meet the requirements of OHMR-R 40-1 Yes ____ No ____6. Is your weight currently at least 5% less than the maximum allowable weightpermitted for your height/age group as described in OHMR 40-1?Yes ____ No ____5. SERVICE RECORD:DOE __________________ DOR _________________ PMOS _________ SMOS ________Training completed (check those that apply or those waived IAW OHMR SOP 203.00, 204.00):BELT _____ 95B _____ BNCOC _____ ANCOC _____ BOC _____6. SPECIAL SKILLS (civilian or military, if applicable)________________________________________________________________________________________________________________________________________________________________________7. APPLICANT’S STATEMENT:I hereby certify that I have read this application and that the information contained hereon isaccurate. I understand that providing misleading or false information will result in my immediate dismissalfrom the QRST program and that I may be subject to administrative disciplinary action.____________________________________________________________________________________Signature Rank Date8. COMMANDER’S APPROVAL____________________________________________________________________________________Signature Printed Name Rank DateNote: in addition to this approval, a letter of recommendation from the applicant’s commanding officer must be submitted with thisapplication.(for office use only)9. QRST COORDINATORApplication has been reviewed and applicant has beenApproved _____ Disapproved _____for enrollment in the QRST program. Applicant’s first training session will be held at the location, time andplace noted on the following page. The applicant will have eighteen months from that date to complete allrequired training IAW OHMR SOP 405.00.A-3