DA Form 7759 United States Army Explosive Ordnance Disposal (Eod) Interview Checklist

DA Form 7759 - also known as the "United States Army Explosive Ordnance Disposal (eod) Interview Checklist" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 7759 - was last revised on May 1, 2017. Download an up-to-date fillable PDF version of the DA 7759 below or request a copy through the chain of command.

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UNITED STATES ARMY EXPLOSIVE ORDNANCE DISPOSAL (EOD) INTERVIEW CHECKLIST
For use of this form, see AR 611-105; the proponent agency is DCS, G-3/5/7.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, US Code, Sections 5014 and 5020.
AUTHORITY:
To be used as a basis for determination of EOD suitability, acceptance into the US. Army EOD program, and processing for
PRINCIPAL PURPOSE:
Naval School Explosive Ordnance Disposal RCMR-SO-CDRSO-CDR (NAVSCOLEOD).
ROUTINE USES:
The information is used for the purpose set forth above and may be provided to other Department of Defense entities for
their use; forwarded to federal, state or local law enforcement agencies for their use.
DISCLOSURE:
Disclosure of personal information is voluntary and no adverse action can be taken against individuals for refusing to
provide information about themselves. Failure to provide the required information may result in disqualification from the
EOD program.
NAME (Last, First, Middle)
RANK
DOD ID
UNIT
MOS
WORK PHONE
HOME PHONE
CELL PHONE
E-MAIL
COMMANDER'S NAME
INTERVIEWER'S NAME/RANK
E-MAIL
SECTION 1 - INITIAL QUALIFICATIONS
A NO answer to any question in Section 1 DISQUALIFIES the Soldier from eligibility unless a waiver is granted by the Chief of
NO
YES
Ordnance, Fort Lee, VA. Waivers may be granted for question 10.
1.
Is the Soldier a CPL or below (enlisted) or Cadet/BOLC student (officer)?
2.
Is the Soldier volunteering for EOD duties?
3.
Is the Soldier willing to work with nuclear and chemical weapons?
4.
Does the Soldier meet the height and weight standards outlined in AR 600-9?
5.
Is the Soldier's GM score 105 or higher (Enlisted only)?
6.
Is the Soldier's GT score 110 or higher (Enlisted only?
7.
Has the Soldier taken and passed a record APFT in the last six months?
Is the Soldier a United States citizen?
8.
Does the Soldier possess a valid state or international motor vehicles operator's license?
9.
10. Does the Soldier have normal color vision?
11. Does the Soldier meet the physical profile (PULHES) of 111111 or 111121?
SECTION 2 - ADMINISTRATIVE
A "YES" answer to any question in Section 2 DISQUALIFIES the Soldier from eligibility.
NO
YES
12. Is the Soldier flagged IAW AR 600-8-2?
13. Is the Soldier claustrophobic?
14. Is the Soldier pregnant?
15. Does the Soldier have dual citizenship with any other country?
16. Does the Soldier hold a passport from any other country other than the United States?
17. Is the Soldier under any court martial proceedings?
Has the Soldier been relieved from EOD training or duty due to punitive action, cancellation of security clearance, or
18.
personal request for relief from EOD?
Page 1 of 8
DA FORM 7759, MAY 2017
APD LC v1.00ES
UNITED STATES ARMY EXPLOSIVE ORDNANCE DISPOSAL (EOD) INTERVIEW CHECKLIST
For use of this form, see AR 611-105; the proponent agency is DCS, G-3/5/7.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, US Code, Sections 5014 and 5020.
AUTHORITY:
To be used as a basis for determination of EOD suitability, acceptance into the US. Army EOD program, and processing for
PRINCIPAL PURPOSE:
Naval School Explosive Ordnance Disposal RCMR-SO-CDRSO-CDR (NAVSCOLEOD).
ROUTINE USES:
The information is used for the purpose set forth above and may be provided to other Department of Defense entities for
their use; forwarded to federal, state or local law enforcement agencies for their use.
DISCLOSURE:
Disclosure of personal information is voluntary and no adverse action can be taken against individuals for refusing to
provide information about themselves. Failure to provide the required information may result in disqualification from the
EOD program.
NAME (Last, First, Middle)
RANK
DOD ID
UNIT
MOS
WORK PHONE
HOME PHONE
CELL PHONE
E-MAIL
COMMANDER'S NAME
INTERVIEWER'S NAME/RANK
E-MAIL
SECTION 1 - INITIAL QUALIFICATIONS
A NO answer to any question in Section 1 DISQUALIFIES the Soldier from eligibility unless a waiver is granted by the Chief of
NO
YES
Ordnance, Fort Lee, VA. Waivers may be granted for question 10.
1.
Is the Soldier a CPL or below (enlisted) or Cadet/BOLC student (officer)?
2.
Is the Soldier volunteering for EOD duties?
3.
Is the Soldier willing to work with nuclear and chemical weapons?
4.
Does the Soldier meet the height and weight standards outlined in AR 600-9?
5.
Is the Soldier's GM score 105 or higher (Enlisted only)?
6.
Is the Soldier's GT score 110 or higher (Enlisted only?
7.
Has the Soldier taken and passed a record APFT in the last six months?
Is the Soldier a United States citizen?
8.
Does the Soldier possess a valid state or international motor vehicles operator's license?
9.
10. Does the Soldier have normal color vision?
11. Does the Soldier meet the physical profile (PULHES) of 111111 or 111121?
SECTION 2 - ADMINISTRATIVE
A "YES" answer to any question in Section 2 DISQUALIFIES the Soldier from eligibility.
NO
YES
12. Is the Soldier flagged IAW AR 600-8-2?
13. Is the Soldier claustrophobic?
14. Is the Soldier pregnant?
15. Does the Soldier have dual citizenship with any other country?
16. Does the Soldier hold a passport from any other country other than the United States?
17. Is the Soldier under any court martial proceedings?
Has the Soldier been relieved from EOD training or duty due to punitive action, cancellation of security clearance, or
18.
personal request for relief from EOD?
Page 1 of 8
DA FORM 7759, MAY 2017
APD LC v1.00ES
SECTION 2 - ADMINISTRATIVE (Continued)
A "YES" answer to any question in Section 2 DISQUALIFIES the Soldier from eligibility.
YES
NO
19.
Does the Soldier have lost time (AWOL) under 10 USC 972 within the last two years?
20. Is the Soldier allergic to explosives or petroleum products?
SECTION 3 - OVERSEAS MOVEMENT & PROFESSIONAL DEVELOPMENT
A "YES" answer to any question in Section 3 MAY disqualify the Soldier from eligibility. The Explosive Ordnance Disposal
YES
NO
Recruiting Team will determine the Soldier's eligibility.
21.
Is the Soldier assigned to a unit alerted or on orders for overseas movement?
Is the Soldier alerted or on orders for overseas movement?
22.
Is the Soldier alerted or on orders for assignment to units alerted for overseas movement?
23.
24.
Has the Soldier completed Phase I, Phase II, or Phase III Advanced Leaders course (formerly known as BNCOC)?
If "YES", which phase?
IAW AR 614-200 paragraph 6-4(k) Soldiers accessed into the EOD program who have previously completed any MOS specific
NCOES technical tract training must complete MOS 89D technical tract training upon completion of the basic EOD course.
Soldier's Initial.
SECTION 4 - RETENTION
The Explosive Ordnance Disposal Recruiting team will determine the Soldier's eligibility based on the Soldier's particular situation.
YES
NO
Will the Soldier have at least *36 months remaining in service upon completion of Phase II EOD School? (Soldier's may use
25.
the BEAR program (if available),Option 3, or application reclassification to reclassify into MOS 89D)
IAW AR 614-200 paragraph 4-6(i)(6) Soldiers will incur a 36 month service remaining requirement upon graduation of Naval
School Explosive Ordnance Disposal. This 36 month requirement must be met BEFORE the Soldier departs their home station
Soldier's Initial.
to attend training .
26. Is the Soldier on assignment at this time? If "YES", what is their report date?
27. Did the Soldier ask for or reenlist for this particular assignment?
Has the Soldier received an enlistment bonus, variable reenlistment bonus, or selective reenlistment bonus for the current
28.
service obligation?
29. Is the Soldier currently serving overseas?
SECTION 5 - SECURITY
Section 5 deals with the Soldier's security clearance. The Soldier is required to have an interim SECRET clearance or higher
YES
NO
in order to be classed for EOD training.
30. Does the Soldier have AT LEAST an interim SECRET clearance? (Soldier's clearance must be verified via JPAS)
Does the Soldier have a completed Single Scope Background Investigation (SSBI) or has one been submitted and opened
31.
through the Soldier's S-2 office?
SECTION 6. DRUG AND ALCOHOL ABUSE
For "YES" answers in Section 6, the interviewer's discretion must be used to determine the reliability of the Soldier. The
interviewer may contact their supporting security manager, the Ordnance Center and Schools Security Division 59th OD BDE,
Fort Lee, VA at (804) 735-9409 or the Explosive Ordnance Disposal Recruiting team at (910) 432-0884 or (910) 396- 5533 for
YES
NO
assistance in determining eligibility.
32. Does the Soldier have a history of drug or alcohol abuse? (this includes one-time use of any illegal substance, DUI, DWI, etc.)
Alcohol abuse is defined as: the recurring use of alcoholic beverages despite negative consequences.
Drug abuse is defined as: the use of illegal drugs, the use of prescription or over-the-counter drugs and/or medications for purposes other than those
for which they were prescribed.
If "YES", please explain the circumstances surrounding the abuse. Provide drug used, frequency and date range of use:
Page 2 of 8
DA FORM 7759, MAY 2017
APD LC v1.00ES
SECTION 6. DRUG AND ALCOHOL ABUSE (Continued)
For YES answers in Section 6, the interviewer's discretion must be used to determine the reliability of the Soldier. The interviewer may contact their
supporting security manager, the Ordnance Center and Schools Security Division 59th OD BDE, Fort Lee, VA at (804) 735-9409 or the Explosive
Ordnance Disposal Recruiting team at (910) 432-0884 or (910) 396- 5533 for assistance in determining eligibility.
YES
NO
Has the Soldier ever been referred (including self referral) to alcohol counseling?
33.
If "YES", please explain. Provide dates of counseling, details, and final outcome:
YES
NO
34. Has the Soldier ever abused prescription medication?
If "YES", please explain. Provide medication taken, frequency, and date range of use:
SECTION 7. MEDICAL
YES
NO
Is the Soldier currently taking ANY medication? (this includes over-the-counter medication or supplements)
35.
If "YES", please explain. Provide medication and dates of use:
YES
NO
Has the Soldier ever received any behavioral health or psychiatric treatment? (Family or individual counseling, PTSD, stress
36.
or anger management)
If "YES", please explain. Provide dates of counseling, details, and final outcome:
YES
NO
37.
Has the Soldier ever been diagnosed with any personality disorder?
If "YES", please explain. Provide date of diagnosis, prognosis, and relevant details:
YES
NO
38. Has the Soldier been diagnosed with PTSD or a Traumatic Brain Injury (TBI)?
If "YES", please explain. Provide date of diagnosis, prognosis, and relevant details:
YES
NO
If so, has the Soldier been treated by a competent medical authority and cleared for duty? (Soldier must provide doctor's
39.
verification)
If "YES", please explain:
Page 3 of 8
DA FORM 7759, MAY 2017
APD LC v1.00ES
SECTION 7 - MEDICAL (Continued)
YES
NO
40.
Has the Soldier ever threatened or attempted suicide?
If "YES", please explain:
YES
NO
Does the Soldier have thoughts of suicide?
41.
If "YES", please explain:
YES
NO
42. Does the Soldier have thoughts of harming themselves or others?
If "YES", please explain:
YES
NO
Does the Soldier have a history of irrational fears or phobias?
43.
If "YES", please explain:
YES
NO
44. Does the Soldier have any allergies?
If "YES", please explain. Provide specific allergy, prescriptions required to treat (if any), and relevant details:
YES
NO
Has the Soldier ever suffered from hot weather injury? (Heat exhaustion or heat stroke)
45.
If "YES", please explain. Provide date of injury, prognosis, and relevant details:
YES
NO
46. Does the Soldier have medical problems that interfere with exercise?
If "YES", please explain. Provide date of injury, prognosis, and relevant details:
YES
NO
Has the Soldier received treatment for any injury in the last 6 months?
47.
If "YES", please explain. Provide date of injury, prognosis, and relevant details:
Page 4 of 8
DA FORM 7759, MAY 2017
APD LC v1.00ES
SECTION 7 - MEDICAL (Continued)
YES
NO
48.
Has the Soldier been under the care of a physician in the past 60 days?
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
YES
NO
Does the Soldier have swollen or painful joints?
49.
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
YES
NO
Does the Soldier have dizziness or fainting spells?
50.
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
YES
NO
51. Does the Soldier have ear, nose, or throat trouble?
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
YES
NO
Does the Soldier have lung or respiratory problems?
52.
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
YES
NO
53. Has the Soldier ever had a head injury?
If "YES", please explain. Provide date of injury, prognosis, and relevant details:
YES
NO
Has the Soldier ever had heart trouble?
54.
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
YES
NO
55. Has the Soldier ever had stomach or gall bladder problems?
If "YES", please explain. Provide date of injury/issue, prognosis, and relevant details:
Page 5 of 8
DA FORM 7759, MAY 2017
APD LC v1.00ES

Download DA Form 7759 United States Army Explosive Ordnance Disposal (Eod) Interview Checklist

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