V. MILITARY RECORD 1. Did you register with the Selective Service System as required. Yes No If yes, provide the following: Registration Number Location (City, State, Zip Code) If no, provide reason: 2. Have you served on active duty in the United States Forces? Yes No If yes, attach a copy of each DD-214 received and proceed to question 3. If no, proceed to Part VI. 3. Branch of military service: 4. Dates of active duty (Month, Date, Year) 5. Military Serial Number or SSAN: To: ž žžFrom: 6. Are you a member of the Reserve? Yes No From: To: Ready Standby Branch of Service: 7. Was any disciplinary action taken against you while you were in the service? Yes No If applicable, be sure to include nonjudicial punishment and Article 15s. If yes, provide details. 8. Have you served in the National Guard? Yes No If yes, provide dates, unit location, and name of Commanding Officer. 9. a. Do you claim Veterans Preference? Yes No b. If yes, indicate dates of service and attach DD-214. c. If claiming Veterans Preference, in addition to your DD-214, you must provide a Standard Form 15 (Application for 10-point Veteran Preference) with appropriate documentation. VI. REFERENCES/SOCIAL ACQUAINTANCES List three people who know you well and live in the United States. They should be good friends, peers, colleagues, college roommates, etc., whose combined association with you covers as well as possible the last 10 years. Do not list your spouse, former spouse, or other relatives, and try not to list anyone who is listed elsewhere on this form. 1. Complete Name Home Address (Last, First, Middle) (City, State, Zip Code) Yrs. Acq. Occupation Home Phone (Including Area Code) DOB or Approximate Age Business Address Business Phone (Including Area Code) 2. Complete Name Home Address (Last, First, Middle) (City, State, Zip Code) Yrs. Acq. Occupation Home Phone (Including Area Code) DOB or Approximate Age Business Address Business Phone (Including Area Code) 3. Complete Name Home Address (Last, First, Middle) (City, State, Zip Code) Yrs. Acq. Occupation Home Phone (Including Area Code) DOB or Approximate Age Business Address Business Phone (Including Area Code)
V. MILITARY RECORD 1. Did you register with the Selective Service System as required. Yes No If yes, provide the following: Registration Number Location (City, State, Zip Code) If no, provide reason: 2. Have you served on active duty in the United States Forces? Yes No If yes, attach a copy of each DD-214 received and proceed to question 3. If no, proceed to Part VI. 3. Branch of military service: 4. Dates of active duty (Month, Date, Year) ž žžFrom: To: From: To: 5. Military Serial Number or SSAN: 6. Are you a member of the Reserve? Yes No Ready Standby Branch of Service: 7. Was any disciplinary action taken against you while you were in the service? Yes No If applicable, be sure to include nonjudicial punishment and Article 15s. If yes, provide details. 8. Have you served in the National Guard? Yes No If yes, provide dates, unit location, and name of Commanding Officer. 9. a. Do you claim Veterans Preference? Yes No b. If yes, indicate dates of service and attach DD-214. c. If claiming Veterans Preference, in addition to your DD-214, you must provide a Standard Form 15 (Application for 10-point Veteran Preference) with appropriate documentation. VI. REFERENCES/SOCIAL ACQUAINTANCES List three people who know you well and live in the United States. They should be good friends, peers, colleagues, college roommates, etc., whose combined association with you covers as well as possible the last 10 years. Do not list your spouse, former spouse, or other relatives, and try not to list anyone who is listed elsewhere on this form. 1. Complete Name (Last, First, Middle) Home Address (City, State, Zip Code) Home Phone (Including Area Code) Business Address Business Phone (Including Area Code) Yrs. Acq. Occupation DOB or Approximate Age 2. Complete Name (Last, First, Middle) Home Address (City, State, Zip Code) Home Phone (Including Area Code) Business Address Business Phone (Including Area Code) Yrs. Acq. Occupation DOB or Approximate Age 3. Complete Name (Last, First, Middle) Home Address (City, State, Zip Code) Home Phone (Including Area Code) Business Address Business Phone (Including Area Code) Yrs. Acq. Occupation DOB or Approximate Age
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