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MCO P1100.73B.pdf - Marine Corps

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DRUG STATEMENT FOR OC/PLC APPLICATIONS<br />

If the answer to block 23 of "Examination of Applicant by recruiting<br />

Officer" (NAVMC 10418-3) is "YES", set forth full circumstances below<br />

including approximate times, amounts taken, and period over which taken:<br />

_______________________________________________________________________<br />

a. Type of drug (or drugs) used:<br />

_______________________________________________________________________<br />

b. Approximate number of times used:<br />

_______________________________________________________________________<br />

c. Amounts taken:<br />

_______________________________________________________________________<br />

d. Method by which taken:<br />

_______________________________________________________________________<br />

e. Inclusive dates of use (be specific):<br />

_______________________________________________________________________<br />

f. Were you convicted or arrested for the drug use admitted?<br />

_______________________________________________________________________<br />

g. Circumstances under which the drug use occurred (use back of this<br />

sheet for statement):<br />

_______________________________________________________________________<br />

_______________________________ ______________________<br />

Signature of Witnessing Officer Signature of Applicant<br />

_______________________________________________________________________<br />

Figure 2-24.--Drug Statement for OC/PLC Applicants.<br />

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