Military Statement of Service
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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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