Veteran’s Career Self Assessment

How did you hear about us? Check all that apply.
Home phone:
Mobile phone:
Last four of SSN:
Current home address:
Which best describes you:
Marital status:
Do you currently have a valid driver’s license?
State that issued your license:
Driver’s license number:
Do you currently have a reliable vehicle or other transportation that can get you to and from a sponsor’s place of employment in your area?
Do you have any geographic limitations (by miles, time, counties) for commuting to and from a sponsor’s place of employment (i.e., within 60 miles of your home, etc.)?
If yes, please explain:

What are your three career occupational interests you desire to pursue/achieve?

Interest 1.)
Interest 2.)
Interest 3.)

Based upon your career interests and desires, who are the top three corporations or entrepreneurs who you would like Bridging The Gap to engage a door opening career opportunity for you ?

Business 1.)
Business 2.)
Business 3.)
Where are your preferred work locations?
Are you currently unemployed or are you looking to change careers? Please explain:
Year started service:
What was your highest rank/pay grade:

If you are currently serving, please answer the following: 

Branch of armed forces currently serving:
What is your current position and what job title/position do you hold:

If you previously served, please answer the following: 

Branch of armed forces previously served:
Year separated service/retired:
Did you receive a DD214?
Did you receive an Honorable Discharge?
If no, please explain:

Please list your highest military honors or awards: (i.e. Meritorious Service Medal, Medal of Honor, etc).

1.) Honor/Award
1.) Honor/Award year
2.) Honor/Award
2.) Honor/Award Year
3.) Honor/Award
3.) Honor/Award Year
4.) Honor/Award
4.) Honor/Award Year

Please list the most recent names of the military bases where you served during your career:

Base 1.)
Base 2.)
Base 3.)
Base 4.)

Please list the most recent job titles and positions you held in the military, as well as the number of years you held those positions:

Job 1.) Title and description
Job 1.) Years worked
Job 2.) Title and description
Job 2.) Years worked
Job 3.) Title and description
Job 3.) Years worked
Job 4.) Title and description
Job 4.) Years worked
Do you have a high school diploma?
Year graduated high school:
High School
If not, do you have a G.E.D.?
Year obtained G.E.D.:
Do you have a college degree?
Year graduated college:
Undergraduate major(s):
Undergraduate degree(s) earned:
Do you have any advanced education or degrees beyond college?
Graduate School
Year graduated graduate school:
Graduate school major(s):
Graduate school degree(s) earned:
Do you have any professional license or certificate in any vocational field?
What type of license or certificate?
Year earned license/certificate:
What organization awarded the license or certificate?
Is the license or certificate still valid?

If you held civilian employment outside the military, please list the most recent civilian employers, job titles, and years employed (inclusive).

Employer 1.) Company name
Employer 1.) Years worked
Employer 1.) Your job title
Employer 1.) Your job duties
Employer 2.) Company name
Employer 2.) Years worked
Employer 2.) Your job title
Employer 2.) Your job duties
Employer 3.) Company name
Employer 3.) Years worked
Employer 3.) Your job title
Employer 3.) Your job duties
Employer 4.) Company name
Employer 4.) Years worked
Employer 4.) Your job title
Employer 4.) Your job duties
At any time while you were in the military, did you receive any UCMJ actions against you?
If yes, please explain the action(s):
At any time while you were in the military, were you ever reduced in rank or pay grade for any reason?
If yes, please explain the reason:
Has your driver’s license ever been suspended or revoked?
If yes, please explain why:
Have you ever been convicted or pled guilty to DWI (driving while intoxicated) or DUI (driving under the influence)?
If yes, please explain which:
Have you ever been convicted or pled guilty to any crime?
If yes, please describe:
Have you ever served time in jail or prison?
If yes, please explain when and where:
Do you currently suffer from any medical or psychological condition(s) that would impair or in any way affect your ability to work or participate in a career internship placed by Bridging The Gap?
If yes, please refine:
Please list any other information you wish to provide to BTG LLC which you feel will help match your career dreams and interests to employers and entrepreneurs. Together we will discuss all your comments and develop a career plan and strategy which will introduce you to our job bank of BTG LLC partnered Veteran Friendly Employers and Entrepreneurs.

By submitting my name to this application, I am certifying and attesting that all information provided is truthful and accurate. When the application was completed and submitted, I was not impaired in any way and I was not under the influence of any drugs or alcohol. I am also certifying and attesting that I was the only person who completed and submitted this application.

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