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HAVE YOU EVER RESIGNED
TO AVOID DISCHARGE? HAVE YOU EVER RECEIVED A GENERAL OR
DISHONERABLE DISCHARGE FROM THE MILITARY SERVICE? (CITE ALL
CASES ATTACH ADDITIONAL SHEET IF NECESSARY.)
YES
NO
DO YOU HOLD ANY ELECTIVE OR APPOINTED GENERAL OFFICE:
FEDERAL, STATE OR LOCAL?
GENERAL INFORMATION
WOULD YOU OBJECT TO THE HUMAN RESOURCES DEPT CONTACTING
YOUR PRESENT EMPLOYER FOR A REFERENCE?
YES NO
APPLICATION Page 1 of 4
EMPLOYER’S NAME AND ADDRESS
DATE
REASON FOR DISCHARGE
OFFICE AND...
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