Placement Interview Forms - Texas Medical Rangers

The information provided here is for TMR personnel managers conducting placement interviews. Download appropriate forms and complete in black ink. Ensure appropriate personal information and signatures from applicants are secured during the placement interview. Compile a photocopied set of the completed forms and submit to the Adjutant of the Medical Reserve Corps (secure current mailing address from TexMedRangers@uthscsa.edu) for final approval, MRC commander signature, and submission to Texas State Guard Headquarters for boarding action and officer accession orders. Enlisted orders will be prepared at the Medical Reserve Corps state level, upon review by the state TMR Command Sergeant Major. All accession orders will be transmitted electronically to the appropriate Group Adjutant for the scheduling of swearing-in ceremony for new Medical Rangers.
Group personnel managers should compile completed TXSG Forms in the sequence that follows:
Warrant (W-1 through W5) and Commissioned Officers (O-1 through O-8):

TXSG 3
TDA assignment (appendix, line number and position) required.
Also, regional MedRanger Group Commander (or adjutant) must sign top signature block in middle of page.

Photographs
2 digital photos: one shoulder and head portrait PLUS one 45 degree side angle hip and above portrait print to center page and fill at least 25% of page or more with image; applicant must print name, sign and date both photos.

TXSG 66
Applicant completes blocks 1-24 and signs. Group personnel officer should have Adjutant or Group Commander complete and sign Section II entries.
The Section III entries will be completed and signed ONLY AFTER TXSG orders have been completed and ONLY on the day of swearing-in.

TXSG 2
Applicants should bring to the Placement Interview a completed Form 2. Check especially for a valid e-mail address and work phone number.

DoJ Form I-9
If the applicant is a salaried employee of a Texas state Health Science Center, simply photocopy their university ID badge. No Form I-9 is required.
If the applicant is not a salaried employee of a Texas state Health Science Center, the I-9 form must be completed:
Applicant should complete Section 1. Group personnel manager should complete Section 2 and personally view the original identity documents.
A current or expired U.S. passport by itself is an adequate identity document; complete info under "List A."
If a passport is not presented, the applicant must present his/her Social Security Card PLUS a valid Texas driver's license. Enter information in the appropriate "List B" and "List C" columns.
The Group personnel manager must photocopy all the identity documents recorded/presented on one sheet and certify by the manager's signature that "All identity documents were viewed as original." The manager should also print his/her name and date. Place this certified photocopy sheet behind completed Form I-9.

Education
If a warrant or commissioned officer applicant, make a photocopy of the applicant's document representing the highest educational degree completed:
EITHER a university degree diploma OR a copy of their final academic college transcript that indicates degree completion. Only one document required for only the highest academic degree. If for MD applicants with current practicing privileges, submit a photocopy of the MD diploma.

DD 214
If the applicant ever served on any U.S. federal armed force (including Coast Guard) active or reserve duty (including National Guard), submit a photocopy of only the most recently issued DD 214 (discharge certificate).

License
If the applicant is applying for MedRanger service for direct contact with patients in his/her health professional capacity, submit a photocopy of a current valid Texas state license (e.g., for MDs, RNs, DDS, DVS, etc.) to practice.

Vita/resume
(optional) If the applicant offers either of these to document experience relevant to a desired MedRanger position, submit a photocopy.

AGTX Form 32
If the applicant is a salaried employee of a Texas state Health Science Center, this form is NOT required. Just make sure that a photocopy of the employees ID tag/card is submitted as an identity document.
If the applicant is not a salaried employee of a Texas state Health Science Center, have the applicant complete items 1-10b in Section I. Also, the applicant should complete the signature block portion in the middle of page 1 and sign and print name at the bottom of page one. On page 2, the Group personnel manager should print the applicant's last and first name at the top right corner. Submit both pages of the Police Record
Check to UT Police Office for a DPS check. UT Police should complete the authentication signature block at the bottom right of page 2 and return both pages to the Group personnel manager. Any adverse information should be secured in a separate file under lock and key at the Group personnel level.

SF 93
The applicant should complete blocks 1-24 and sign, print name in the middle of page 2. For purposes of completing this form, tell the applicant:
"For block 11-24 conditions, provide an explanation in the open space top of page 2 right side IF:
you have an allergic reaction to any substance,
your physical condition is permanently effected where you cannot stand for 60-90 minutes, negotiate 2 flights of stairs up and down on your own, or work extended shifts of 8-12 hrs per day for 3-5 days."
If your "yes" condition is more than 5 years expired, simply indicate the year. If it is still a current condition (e.g., you are permanently on specific prescription medications), please indicate so on page 2, top right."
Group Personnel Managers should review entries and provide completed SF 93 to a MedRanger MD for completion of block 25 and the MDs signature, printed name and date at the bottom of page 2. The standard entry for block 25 if there are no significant limitations to duty is: "Applicant is fit for Texas State Guard duty."

Form 8A
Applicants should complete all demographic information they know. If they have a current firearms license, so indicate. All applicants must place date and sign in the section towards the bottom of form labeled "Sworn Statement of Applicant." The Group personnel manager should have the Group commander review the completed Form 8A and sign, print name and date bottom left of form. A completed form 8A is the basis for issue of a TXSG-MRC Identity Card. Ideally, this identity card should be presented at the applicant's swearing-in ceremony or ASAP.

Enlisted Medical Rangers (E-1 through E-9):

TXSG 5
TDA assignment (appendix, line number and position) required.
Also, regional MedRanger Group Commander (or adjutant) must sign top signature block in middle of page.
For enlisted MedRangers, orders number will be entered top left block by the Medical Reserve Corps (state-level) adjutant.

Photographs
2 digital photos: one shoulder and head portrait PLUS one 45 degree side angle hip and above portrait
print to center page and fill at least 25% of page or more with image; applicant must print name, sign and date both photos.

TXSG 4
Applicant completes blocks 1-24 and signs. Group personnel officer should have Adjutant or Group Commander complete and sign Section II entries.
The Section II "Oath of Enlistment" entries will be completed and signed ONLY AFTER TXSG orders have been completed and ONLY on the day of swearing-in.

TXSG 2
Applicants should bring to the Placement Interview a completed Form 2. Check especially for a valid e-mail address and work phone number.

DoJ Form I-9
If the applicant is a salaried employee of a Texas state Health Science Center, simply photocopy their university ID badge. No Form I-9 is required.
If the applicant is not a salaried employee of a Texas state Health Science Center, the I-9 form must be completed:
Applicant should complete Section 1. Group personnel manager should complete Section 2 and personally view the original identity documents.
A current or expired U.S. passport by itself is an adequate identity document; complete info under "List A."
If a passport is not presented, the applicant must present his/her Social Security Card PLUS a valid Texas driver's license. Enter information in the appropriate "List B" and "List C" columns.

The Group personnel manager must photocopy all the identity documents recorded/presented on one sheet and certify by the manager's signature that "All identity documents were viewed as original." The manager should also print his/her name and date. Place this certified photocopy sheet behind completed Form I-9.

Education
Enlisted members may submit a photocopy of any college degree earned (e.g. associates degree). Note: If an applicant has a baccalaureate degree or higher and desires to serve as an enlisted MedRanger, this is allowable and acceptable. If this applies, make a photocopy of the applicant's document representing the highest educational degree completed: EITHER a university degree diploma OR a copy of their final academic college transcript that indicates degree completion. Only one document required for only the highest academic degree. If for RN or LPN applicants with current practicing privileges, submit a photocopy of the diploma or certification indicating RN or LPN.

DD 214
If the applicant ever served on any U.S. federal armed force (including Coast Guard) active or reserve duty (including National Guard), submit a photocopy of only the most recently issued DD 214 (discharge certificate).

License
If the applicant is applying for MedRanger service for direct contact with patients in his/her health professional capacity, submit a photocopy of a current valid Texas state license (e.g., for RNs, EMTs, LPNs, etc.) to practice.

Vita/resume (optional)
If the applicant offers either of these to document experience relevant to a desired MedRanger position, submit a photocopy.

AGTX Form 32
If the applicant is a salaried employee of a Texas state Health Science Center, this form is NOT required. Just make sure that a photocopy of the employees ID tag/card is submitted as an identity document.
If the applicant is not a salaried employee of a Texas state Health Science Center, have the applicant complete items 1-10b in Section I. Also, the applicant should complete the signature block portion in the middle of page 1 and sign and print name at the bottom of page one. On page 2, the Group personnel manager should print the applicant's last and first name at the top right corner. Submit both pages of the Police Record
Check to UT Police Office for a DPS check. UT Police should complete the authentication signature block at the bottom right of page 2 and return both pages to the Group personnel manager. Any adverse information should be secured in a separate file under lock and key at the Group personnel level.

SF 93
The applicant should complete blocks 1-24 and sign, print name in the middle of page 2. For purposes of completing this form, tell the applicant: "For block 11-24 conditions, provide an explanation in the open space top of page 2 right side IF:
you have an allergic reaction to any substance,
your physical condition is permanently effected where you cannot stand for 60-90 minutes, negotiate 2 flights of stairs up and down on your own, or work extended shifts of 8-12 hrs per day for 3-5 days."

If your "yes" condition is more than 5 years expired, simply indicate the year. If it is still a current condition (e.g., you are permanently on specific prescription medications), please indicate so on page 2, top right."

Group Personnel Managers should review entries and provide completed SF 93 to a MedRanger MD for completion of block 25 and the MDs signature, printed name and date at the bottom of page 2. The standard entry for block 25 if there are no significant limitations to duty is: "Applicant is fit for Texas State Guard duty."

Form 8A
Applicants should complete all demographic information they know. If they have a current firearms license, so indicate. All applicants must place date and sign in the section towards the bottom of form labeled "Sworn Statement of Applicant." The Group personnel manager should have the Group commander review the completed Form 8A and sign, print name and date bottom left of form. A completed form 8A is the basis for issue of a TXSG-MRC Identity Card. Ideally, this identity card should be presented at the applicant's swearing-in ceremony or ASAP.