ENLISTMENT/REENLISTMENT DOCUMENT

ARMED FORCES OF THE UNITED STATES


Privacy Act Statement

AUTHORITY: 5 USC 3331; 32 USC 708; 44 USC 708 and 3101. 10 USC 133, 265, 275, 504, 508, 510, 591, 672(d), 678, 837, 1007, 1071 through 1087, 1168, 1169, 1475 through 1480, 1553, 2107, 2122, 3012, 5031, 8012, 8033, 8496, and 9411; 14 USC 351 and 632; and Executive Order 9397, November 1943 (SSN).

PRINCIPAL PURPOSES: To record enlistment or reenlistment into the U.S. Armed Forces. This information becomes a part of the subject's military personnel records which are used to document promotion, reassignment, training, medical support, and other personnel management actions. The purpose of soliciting the SSN is for positive identification.

ROUTINE USES: This form becomes a part of the Service's Enlisted Master File and Field Personnel File. All uses of this form are internal to the relevant Service.

DISCLOSURE: Voluntary; however, failure to furnish personal identification information may negate the enlistment/reenlistment application.


A. ENLISTEE/REENLISTEE IDENTIFICATION DATA

1. NAME (Last, First, Middle) 2. SOCIAL SECURITY NUMBER
3. HOME OF RECORD (Street, City, State, ZIP Code) 4. PLACE OF ENLISTMENT/REENLISTMENT

(Mil. Installation, City, State)

5. DATE OF ENLISTMENT/

REENLISTMENT (YYMMDD)

6. DATE OF BIRTH

(YYMMDD)

7.PREV MIL SVC UPON ENL/REENLIST

a. Total Active Military Service

b. Total Inactive Military Service

YEARS MONTHS DAYS


B. AGREEMENTS

8. I am enlisting/reenlisting in the United States (list branch of service) ____________________ this date for ____________________ years and ____________________ weeks beginning in pay grade _____. The additional details of my enlistment/reenlistment are in Section C and Annex(es) ____________________.

9. FOR ALL ENLISTEES OR REENLISTEES: Many laws, regulations, and military customs will govern my conduct and require me to do things a civilian does not have to do. The following statements are not promises or guarantees of any kind. They explain some of the present laws affecting the Armed Forces which I cannot change but which Congress can change at any time.

10. MILITARY SERVICE OBLIGATION FOR ALL MEMBERS OF THE ACTIVE AND  RESERVE COMPONENTS, INCLUDING THE NATIONAL GUARD.

11. FOR ENLISTEES / REENLISTEES IN THE NAVY, MARINE CORPS, OR COAST GUARD: I understand that if I am serving on a naval vessel in a foreign waters, and my enlistment expires, I will be returned to the United States for discharge as soon as possible consistent with my desires. However, if essential to the public interest, I understand that I may retained on active duty untilthe vessel returns to the United States. If I am retained under these circumstances, I understand that I will be discharged not later than 30 days after my return to the United States; and, that except in time of war, I will be entitled to an increase in basic pay of 25 percent from the date my enlistment expires to the date of my discharge.

12. FOR ALL MALE APPLICANTS: Completion of this form constitutes registatration with the Selective Service System in accordance with the Military Selective Service Act. Incident thereto the Department of Defense may transmit my name, permanent address, military address, Social Security Number, and birthdate to the Selective Service System for recording as evidence of the registration.


D. CERTIFICATION AND ACCEPTANCE

13a. My acceptance for enlistment is based on the information I have given in application for enlistment. If any of that information is flase or incorrect, this enlistment may be voided or terminated administratively by the Government or I may be tried by a Federal, civilian, or military court and, if found guilty, may be punished.

I CERTIFY THAT I HAVE CAREFULLY READ THIS DOCUMENT. ANY QUESTIONS I HAD WERE EXPLAINED TO MY SATISFACTION. I FULLY UNDERSTAND THAT ONLY THOSE AGREEMENTS IN SECTION B OF THIS DOCUMENT OR RECORDED ON THE ATTACHED ANNEX(ES) WILL BE HONORED. ANY OTHER PROMISES OR GUARANTEES MADE TO ME BY ANYONE ARE WRITTEN BELOW: (If none, X "NONE" and initial.) ____ NONE _______ (Initials of enlistee/reenlistee)

b. SIGNATURE OF ENLISTEE / REENLISTEE

c. DATE SIGNED (YYMMDD)

14. SERVICE REPRESENTATIVE CERTIFICATION

b. NAME (Last, First, Middle) c. PAY GRADE d. UNIT / COMMAND NAME
e. SIGNATURE f. DATE SIGNED (YYMMDD) g. UNIT / COMMAND ADDRESS (City, State,

ZIP Code)


E. CONFIRMATION OF ENLISTMENT OR REENLISTMENT

15. IN THE ARMED FORCES EXCEPT THE NATIONAL GUARD (ARMY OF AIR):

I, ___________________, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, fereign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to law and regulations. So help me God.

16. IN THE NATIONAL GUARD (ARMY OR AIR):

I, ___________________, do solemnly swear (or affirm) that I will support and defend the Constitution of the United States and the State of ____________________ against all enemies, fereign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the Governor of ____________________ and the orders of the officers appointed over me, according to law and regulations. So help me God.

17. IN THE NATIONAL GUARD (ARMY OR AIR):

I do hereby acknowledge to have voluntarily enlisted / reenlisted this __________ day of __________ 19_____ in the ____________________ National Guard and as a Reserve of the United States (list branch of service) ____________________ with membership in the ____________________ National Guard of the United States for a period of __________ years, __________ months, __________ days, under the conditions prescribed by law, unless sooner discharged by proper authority.

18a. SIGNATURE OF ENLISTEE / REENLISTEE b. DATE SIGNED (YYMMDD)

19. ENLISTMENT / REENLISTMENT OFFICER CERTIFICATION

b. NAME (Last, First, Middle) c. PAY GRADE d. UNIT / COMMAND NAME
e. SIGNATURE f. DATE SIGNED (YYMMDD) g. UNIT / COMMAND ADDRESS (City, State,

ZIP Code)


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