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Military Statement of Service Form

Military Statement Service Template

Military Statement of Service

Full Name:


SSN: ___________________________

Grade / Rank: ____________________

Branch of Service: _________________

Please Check One:

[__] Officer

[__] Student: GSN/SOM Year______

[__] Enlisted

Information for paperwork to be started:

DOB: ____/____/______

Active Duty Service Date:


End of Active Obligated Service Date:

____/____/______ (Officers: Indefinite)

Marital Status: _______________

Prior Service: [__] Yes or [__]

No Period: ___________

Lost Time: ____________________

Pending UCMJ, Court Martial or Civil Actions: [__] Yes or [__] No _______

Duty Station Upon Graduation: (Four Year and PCSing Soldiers Only):


Additional Information:


Base Pay: _______________________

BAH: ___________________________

BAS: ___________________________

Other: __________________________

_______________________ Date_____
Soldier Signature



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