MILITARY DEPARTMENT OF SOUTH CAROLINA
SOUTH CAROLINA STATE GUARD
551 Granby Lane ● Columbia, S.C. 29201 ● (803) 253-6210
SG.SC.GOV
State Guard Applicant:
T
hank you for your interest in the South Carolina State Guard. You have taken the first step toward becoming a
member of one of the State’s oldest military organizations. The State Guard is a part of the South Carolina Military
Department and there are a number of qualifications that all new personnel must meet. Some of these requirements
are as follows:
B
e between the ages of Seventeen (17) years (with parent / guardian consent) and Seventy-One 71 years of
age.
A US citizen or a resident of South Carolina. Non-US citizens must show proof of application for Citizenship.
Meet basic medical condition criteria. (Cannot have a medical condition that would endanger self or others).
No record of drug or alcohol abuse.
No visible tattoos on neck above the collar or the t-shirt or below the wrist bone.
Meet Height and Weight requirements (Reference the Height/Weight chart included with this document. See:
Form 20/66 Record of Basic Data: Height /Weight Chart.
An Honorable or General Discharge (Under Honorable Conditions) if prior active or reserve military service.
Cannot be a current member of an active or reserve component of the US armed Forces or of another State
Defense Force.
If you meet the membership requirements listed above, please complete the attached Record of Basic
Data form and be prepared to submit all REQUIRED documents that apply. Your completed application
will not be processed until ALL REQUIRED documents are submitted to the SCSG Administrator’s
Office. Email complete application to [email protected].
I
f prior Federal service – copy of DD214 or NGB22 or discharge from the Reserves-REQUIRED
SCSG Form 20/66 Record of Basic Data (attached) – REQUIRED
Copy of Diploma showing your highest achievement – REQUIRED
Copy of Social Security Card – REQUIRED
Copy of birth certificate (Current passport is acceptable) – REQUIRED
Applicants must complete the attached “Notice and Authorization for Background Check” – REQUIRED
Complete a SCSG Medical Service Inquiry Form 801 (attached) – REQUIRED
Any special training documents or civilian licensed shills that you would like to be included in your Enlistment
Packet i.e., CDL – OPTIONAL
Do you read or speak any languages other than English? Do you know American Sign Language. Please Explain:
H
ow did you hear about the S.C. State Guard?
SCSG Form 20/66 (REV 14 August 2023)
SCSG Height/Weight Chart
(Rev Oct 2014)
Male [weight in pounds by age] Female [weight in pounds by age]
Height 17-20 21-27 28-39 40+ Height 17-20 21-27 28-39 40+
58 58 139 141 142 144
59 59 144 154 146 148
60 152 156 159 161 60 148 149 151 153
61 156 160 164 166 61 152 154 155 157
62 161 164 168 170 62 156 158 160 162
63 165 169 173 175 63 161 163 164 166
64 170 174 178 180 64 165 167 169 171
65 175 179 183 185 65 170 172 174 176
66 180 183 188 190 66 175 176 178 181
67 185 189 194 196 67 179 181 183 186
68 190 194 199 201 68 184 186 188 191
69 195 199 204 206 69 189 191 193 196
70 200 205 209 212 70 194 196 198 201
71 205 209 214 217 71 199 201 203 206
72 210 215 220 223 72 204 206 208 211
73 215 220 225 228 73 209 211 214 217
74 221 226 231 234 74 214 217 219 222
75 226 232 237 240 75 220 222 224 228
76 232 237 243 246 76 225 227 230 233
77 238 243 249 252 77 230 233 235 239
78 243 249 253 258 78 236 238 241 245
79 249 255 261 264 79 241 244 247 250
80 254 260 267 270 80 247 250 253 256
Add 6 pounds per inch for males and 5 pounds for females over 80 inches in height.
Page$1$of$2
SUFFIX: GENDER$(M$or$F): BIRTH$DATE$(MM/DD/YYYY): Last$Four$Digits$of$SSN:$$
$M$ $F
COUNTRY$OF$CITIZENSHIP:
IF$NOT$U.S.$CITIZEN,$PLAN$TO$NATURALIZE:$$$Y$or$N
CITY
$Y$$$$$$$$$$$$N
ZIP$CODE
STATE ZIP$CODE
HEIGHT$(INCHES): WEIGHT$(LBS): HAIR$COLOR: EYE$COLOR: BLOOD$TYPE: RACE:
SUPV$PH$#:
WORK$PH$# START$DATE$(MM/DD/YYYY):
STATE ZIP$CODE:
STATE: ZIP$CODE:
CELL$PH$# HOME$PH$#
SCHOOL/INSTITUITION YEARS$ATTENDED$(XX$+$XX) DEGREE$CONFERRED EXPL$NOTE,$IF$NEEDED
IF NONE, CHECK HERE:
TYPE BRANCH ACTIVE$or$RESERVE YEARS$SERVED$(XX$+$XX) DISCHARGE$or$RETIREMENT DOCUMENT$ATTACHED
FEDERAL
$$A$$$$$$$$$$$R
$$D$$$$$$$$$$$R
DD+214$$$$$Y$$$$$$$N
NATIONAL$GUARD
$$A$$$$$$$$$$$R
$$D$$$$$$$$$$$R
NGB+22$$$$$Y$$$$$$$N
STATE$GUARD
$$A$$$$$$$$$$$R
$$D$$$$$$$$$$$R
OTHER$(ROTC,$CAP,$etc)
SPECIAL$SKILLS,$LICENSES,$or$CERTIFICATIONS: ISSUING$AUTHORITY$or$JURISDICTION: DATE$ISSUED: EXPIRATION$DATE:
EMPLOYMENT INFORMATION
CURRENT$EMPLOYER:
EMERGENCY CONTACT INFORMATION
NAME:$$LAST
SUPERVISOR:
EMAIL:
MAILING$ADDRESS$(IF$DIFFERENT):
CITY
EMAIL:
PLACE$OF$EMPLOYMENT$STREET$ADDRESS:
CITY
POSITION:
FIRST$
RELATIONSHIP:
RESIDENTIAL$STREET$ADDRESS:
CITY:
RECORD OF BASIC DATA
APPLICANT INFORMATION
RESIDENTIAL$STREET$ADDRESS:
MIDDLE$or$"NMN"
CITY
NAME:$$LAST
FIRST$
NICKNAME:
CIVILIAN EDUCATION (List most recent first):
EMAIL:
LOCATION$(CITY,$STATE)
MILITARY SERVICE INFORMATION
Other Ph #
STATE
CELL PH #
IF U.S. BIRTH, LOCATION: STATE
HOME PH #
SCSG FORM 20/66(REV 10 AUG 23)
SKILLS AND CERTIFICATIONS
ADDITIONAL INFORMATION
ARE YOU CURRENTLY A SC State Employee
IF YES, PLEASE PROVIDE SCEIS NUMBER:
SPECIAL$SKILLS,$LICENSES,$or$CERTIFICATIONS: ISSUING$AUTHORITY$or$JURISDICTION: DATE$ISSUED: EXPIRATION$DATE:SPECIAL$SKILLS,$LICENSES,$or$CERTIFICATIONS: ISSUING$AUTHORITY$or$JURISDICTION: DATE$ISSUED: EXPIRATION$DATE:
Please provide Usernames / Handles for all “Social Media Accounts." Attach a separate sheet if additional space is required. Please initial this block to acknowledge that you
are aware that social media will be reviewed for the suitability of service in the State Guard. Failure to supply this information will be grounds for rejection of the application.
ARE YOU CURRENTLY A SC State Employee
INITIALS
Page$2$of$2
INITIAL BELOW:
Y$___________$$N$__________
CERTIFICATION & SIGNATURE
SCSG OFFICE USE ONLY
LEGAL INFORMATION -- YOU MUST INITIAL YOUR ANSWERS
Are$you$now$or$have$you$ever:$(1)$been$a$member$of$an$organization$dedicated$to$terrorism,$either$with$an$awareness$of$the$organization's$dedication$to$that$end,$or$
with$the$specific$intent$to$further$such$activities;$(2)$knowingly$engaged$in$any$acts$of$terrorism$(3)$advocated$any$acts$of$terrorism$or$activities$designed$to$overthrow$
the$U.S.$Government$by$force;$(4)$been$a$member$of$an$organization$dedicated$to$the$use$of$violence$or$force$to$overthrow$the$U.S.$Government,$and$which$engaged$
in$activities$to$that$end$with$an$awareness$of$the$organization's$dedication$to$that$end$or$the$specific$intent$to$further$such$activities;$(5)$been$a$member$of$an$
organization$that$advocates$or$practices$commission$of$acts$of$force$or$violence$to$discourage$others$from$exercising$their$rights$under$the$U.S.$Constitution$or$any$
State$of$the$U.S.$with$the$specific$intent$to$further$such$action;$or$(6)$knowingly$engaged$in$activities$designed$to$overthrow$the$U.S.$Government$by$force?
ADDITIONAL INFORMATION THAT THE APPLICANT BELIEVES NECESSARY TO SUPPORT MEMBERSHIP IN S.C. STATE GUARD:
I authorize any law enforcement agency to release to any officer of the SC State Guard any record of criminal history on file concerning me. I certify that the above information is true, complete and accurate to the best of
my knowledge and belief and is made in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both, (U.S. CODE, TITLE 18, SECTION 1001), and may
lead to immediate discharge. ELECTRONIC SIGNATURE AGREEMENT: The SCSG asks that applicants complete SCSG form 20-66 and sign it electronically, thus replacing the manual/handwritten. Subsequent written
signatures may be required prior to acceptance into the SCSG.By selecting the "I ACCEPT," you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual/
handwritten. ACKNOWLEDGMENT: My electronic signature is legally binding. please make the appropriate selection and provide your signature.SELECT ONE.
DATE (MM/DD/YYYY):
BOARD DATE: RANK ASSIGNED: UNIT ASSIGNED: LINE NUMBER: SCSG EMAIL:
DATE OF OATH:
NAME: LAST FIRST MIDDLE or "NMN"
SIGNATURE:
REASON FOR REJECTION/DECLINE:
SCSG FORM 20/66(REV 10 AUG 23
Application Submission Instructions
Thank you for your interest in the South Carolina State Guard.
1. Save this form as a PDF and then submit email to [email protected]
2. Please maintain a copy of this form for your personal records
Print
Save
Reset
Name:__________________________________________________________ SSN(Last4)________________
Address:________________________________________________________ CivilianOccupation:_________________________
Phone:____‐____‐_______Cell:____‐____‐_______Work:____‐____‐_______
DOB:_____/_____/________ Height(inches):___________Weight:___________
MedicalHistory
Allergies:______________________________ Glasses:
Yes No
______________________________________ Contacts:
Yes No
______________________________________ HearingAids:
Yes No
Other:_________________________________
______________________________________
______________________________________ BloodType:______________
Doyouhaveahistoryof:
Headaches Pneumonia Diabetes RheumaticFever
ShortnessofBreath Ulcer(s) Hepatitis Glaucoma
HeartPalpitations GIDisorder(s) Anemia Epilepsy
HeartMurmur LactoseIntolerance Osteoarthritis BleedingDisorder
HeartAttack GallbladderDisease Hypertension(HighB/P) KidneyDisease
ChestPain ProstateDisease Depression ThyroidDisorder
Dizziness/Fainting GYNDisease/Disorder Gout MentalHealthIssues
PeripheralVascularDisease BowelIrregularities Stroke TB
Allergies/HayFever HearingLoss Chronicinfectiousdisease Cancer
Bronchitis Tinnitus(ringinginears) HIV ShoulderProblems
KneeorHipProblems BackProblems
Other:_
________________________________________________________________________________________________
Tobaccouse: Yes
No Smoke
Smokel
ess Vapor
Alcoholuse:Howmanydrinksdoyouhaveinaweek?_____________________________________________________________
Doyouhavesleepproblems? Yes NoTroublegoingtosleeporstayingasleep? Yes No
SCSG FORM 801 – Medical (10 AUG 2023) Page 1 of 2
use drop down menu for DOB
SOUTHCAROLINASTATEGUARDMEDICALSERVICEINQUIRY
Save this form as a PDF and then submit email to
Excessivesleepinessduringtheday?YesNoSleepApnea?YesNoDoyouuseaCPAP?YesNo
ExerciseRoutine: Nutrition:
Noexerciseplan Doyouhaveappetiteproblems?YesNo
Lessthan3xperweek SpecialDiet:_______________________________
3xperweekformorethan30minutes
Morethanabove
Doyoufeelyouare“fit”:
Yes NoDoyouneedhelpstartingafitnessplan:Yes No
Doyouhavecontact/exposuretoblood/bodyfluidsatyourcivilianjobsite:
Yes No
LivingWill:
YesNoImmunizations:FluHepBPneumoniaTetanusShingles
FamilyphysicianName/Phone:_________________________________()_____‐_____‐_________
NextofKin(NOK)Name/Phone:_________________________________()_____‐_____‐_________
OtherPhoneNumbers:___________________________________________________
ActivityRestrictions:___________________________________________________________________________________________
___________________________________________________________________________________________________________
Hospitalizations/Surgeriesinpast24months:
NoYes‐Explain:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Fracturesinpast24months:
No Yes‐Explain:___________________________________________________________________
Medications(prescribedandover‐the‐counter):_____________________________________________________________________
____________________________________________________________________________________________________________
Remarks:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
SIGNATURE:___________________________________________PRINTLASTNAME:___________________DATE:___________
Officeuseonly
CategoryA CategoryB CategoryC
FULLYDEPLOYABLE DEPLOYW/RESTRICTIONS NON‐DEPLOYABLE
PAGE 2 of 2
OFFICE OF THE ADJUANT GENERAL
Notice and Authorization For Background Check
1 of 2 14 June 2023
NOTICE
This is to inform you that the Office of the Adjutant General may obtain information about you
and/or your history related to potential criminal activity. The report from authorized sources may
include, among other information, arrest, conviction, and driving record information. The Office
of the Adjutant General may additionally obtain information concerning your background,
character, medical conditions, employment, education and military experience. Information
obtained by the Office of the Adjutant General will be used only for the purposes of assessing
your suitability to become or continue as an employee of the State of South Carolina or Agency
volunteer.
AUTHORIZATION
I hereby authorize and instruct the Office of the Adjutant General, to procure a report(s) on me,
including criminal background history, which I understand may include, among other information:
arrest, conviction, and driving record information. I also authorize and instruct the Office of the
Adjutant General to verify my Social Security number and to investigate my background and
character in any manner they see fit to evaluate my suitability to be or remain as an employee of
the State of South Carolina including obtaining information from medical providers, employers,
educational institutions, military agencies, and other sources. If I become an employee of the
State of South Carolina or Agency volunteer, I authorize the Office of the Adjutant General to
repeat these investigations at any time for as long as I remain an employee of the State or an
Agency volunteer. I authorize and instruct any individual, corporation, and public or private entity
having knowledge about me to furnish the Office of the Adjutant General any and all information
they may have regarding me. I unconditionally release and hold harmless the Office of the
Adjutant General, and its officers, agents, and employees, and any person furnishing information
to them pursuant to this authorization, from any liability, claims, charges, costs, or causes of action
which I or my heirs, executors, or assigns may have as a result of the delivery, disclosure, non-
disclosure, or omission of any information. I additionally agree to indemnify the Office of the
Adjutant General and its officers, agents and employees for any and all attorney fees, court costs,
and other expenses resulting from investigating my background, gathering information concerning
me, or verifying personal information about me. I understand the information obtained by the
Office of the Adjutant General pursuant to this authorization is confidential and will be protected
as much as reasonably possible. Furthermore, I understand that the Office of the Adjutant
General holds the right to deny my selection and/or continuation as an employee or Agency
volunteer based on the results of these investigations, and, for confidentiality, is not required to
disclose the reason(s) for doing so. A photocopy of this authorization may be accepted in lieu of
the original.
Applicant’s Signature: ___________________________________ Date: _____________
If the above individual is under eighteen (18) years old, the following section must be
completed by the Parent / Guardian: I understand and agree that this Agreement is binding
on me, my child / ward (named above), our heirs, assigns and personal representatives. I affirm
that I am eighteen (18) years old or more and that I am the parent or legal guardian of the child /
ward named above.
Parent / Guardian Signature: ___________________________________
Parent / Guardian Printed Full Name:
___________________________________
Date:
_______________
2 of 2 14 June 2023
PERSONAL IDENTIFICATION AND BACKGROUND INFORMATION
(Please Print)
Complete Legal Name: Gender: M F
If name changed (through marriage or otherwise), former name:
Date of Birth: Social Security Number:
Driver’s License Number: State Expires
Residences (Past 7 years)
Current Address:
City State Zip Code
Address:
City State Zip Code
Address:
City State Zip Code
Have you ever been charged with or convicted of a misdemeanor? No Yes
Details:
Have you ever been charged with or convicted of a felony? No Yes
Details:
Have you ever been cited for a traffic violation? No Yes
Details:
