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START THE PROCESS NOW.

If you decide to submit your application, you will be assigned to work with a specific Army Reserve recruiter, who will help you through every stage in the process. We can often process you as quickly as you can provide the documents we need. Some Physicians are exceptionally motivated and can complete the required steps in about 2 months. But generally, it will take 3 to 4 months to gather the necessary documents, fill out the forms, schedule the physical examination, review the results, and submit your completed packet to the Army Reserve’s Review Board.

There is an extensive credentialing process necessary to become a Commissioned Officer in the U.S. Army Reserve. As the first step, please fill out the following Information Request Form and click “Submit.” We will then contact you by mail, telephone or e-mail about how we will proceed.

INFORMATION REQUEST FORM

All fields are required.

YOUR CONTACT INFORMATION

First Name:
Last Name:
Address:
City:	State:	Zip:
Home Phone:	Cell Phone:
E-mail:
Yes, please send me information by e-mail about future ARMC opportunities

LICENSURE

Do you now have or have you ever held a license to practice medicine? Yes No

Where was it issued?

Is it unrestricted? Yes No

If no, please explain:

Is it current? Yes No

If no, please explain:

Has it ever been suspended or revoked? Yes No

If yes, please explain:

CURRENT EMPLOYMENT

Are you currently employed as a Physician? Yes No

Name of Current Employer:

Current working hours: (hh-hh am/pm)

Best time to reach you:

EDUCATION

Are you a graduate of an American Medical Association (AMA) or American Osteopathic Association (AOA) accredited medical school? Yes No

Name of school that granted or will grant degree?

Location of School:

Medical School Graduation Date? (mm/dd/yy)

Where did you perform your Residency?

Year Completed: (mm/dd/yy)

Where did you perform your Fellowship, if any?

Year Completed: (mm/dd/yy)

What is your primary medical specialty?

Are you Board Certified or Board Eligible? Yes No

Foreign Graduate? Yes No

Completed ECFMG? Yes No

Date: (mm/dd/yy)

Location:

Completed 5th Pathway? Yes No

Date: (mm/dd/yy)

Location:

PERSONAL INFORMATION

Current Age:
Are you a U.S. Citizen? Yes No
If Yes, By Birth Naturalized Born Abroad by U.S. Parents
If No, Visa Permanent Resident Neither

PRIOR MILITARY SERVICE

Are you now or have you ever been a member of any branch of the Armed Forces, including the Reserve components? Yes No
Branch:
Highest Rank Held:

OTHER

Where did you hear about this opportunity?

Other than yourself, can you refer to us a Physician you think would benefit from the Army Reserve, and the financial, professional and personal rewards we offer?

First Name:
Last Name:
Address:
City:	State:	Zip:
Home Phone:	Cell Phone:
E-mail:

Thank You. Please check your answers. When satisfied, click submit.