FORM 5: MILITARY SERVICE



FORM 5: MILITARY SERVICE

Applicant(s full name:

Applicant(s social security number:

SERVICE STATUS:

M-1. __ I am actively service as a member of the United States armed services.

Rank:

Serial Number:

M-2 __ I was formerly a member of the United States armed services.

Rank:

Serial Number:

M-3. __ I am/was a member of a foreign military service.

Country:

Rank:

Serial Number:

M-4. If you marked any of the above boxes, mark the box below that identifies the branch of service:

Regular Armed Forces: _ Air Force _ Army _ Coast Guard _ Marines _ Navy

Reserve Components: _ Air Force _ Army _ Coast Guard _ Marines _ Navy

National Guard: _ Air Force _ Army _ Other: ________________________

FORM 5: MILITARY SERVICE

FOR ACTIVE DUTY AND RESERVE PERSONNEL ONLY: __ Active __ Reserve

M-5. Name, address, and telephone number of present duty station:

M-6. Name and rank of Commanding Officer:

INACTIVE DUTY: If you marked box M-2 (above), provide the following information:

M-7. Did you receive an honorable discharge? _ YES _ NO

M-8. Have you been subject to court-martial proceedings? _ YES _ NO

M-9. Have you been subject to non-judicial punishment (Article 15 UCMJ)? _ YES _ NO

M-10. Were you allowed to resign in lieu of a court-martial or other discipline? _ YES _ NO

M-11. Have you been administratively discharged? _ YES _ NO

M-12. If you answered “NO” to item M-7 or ”YES” to items M-8, M-9, M-10, or

M-11, explain the circumstances below.

1. Date of Incident or period of time involved:

2. Duty station (include address):

3. Commanding officer’s name and rank:

4. Disposition (include any punishment):

5. Explanation:

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Documents Required: If you mark Box M-2 below, you must provide a copy of each of your Separation from Active Duty forms (DD Form 214) for each period of military service employment.

If you served in the National Guard and have separated from service, provide a copy of the National Guard’s Separation and Record of Service form. (NGB Form 22.)

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