No of Dependent

Sex/Race#S -

SECTION I – Assignment InformationOS/Deployment Combat Duty

# M

RANK - DORBRIEF DATE NAME PMOS SSN COMPONENTENLISTED RECORD BRIEF

SECTION II – Security Data SECTION III – Service Data SECTION IV – Personal/Family Data

Start-End Date CT MO TS TTPSI Status Fld Det PS StatPSI Invest INITPSI Invest Compl

#L -BASD PEBD BESDETS DIEMS Reenl Elig/Prohib# Days Lost AGCM Dt AGCM Elig Dt

Date of Birth BirthplaceCountry of CitzNo of Dependent Adults/ChildrenC

# M

ORTOT:

Dwell TimeStart

Month - Days

DEROS

DROS

p

SECTION V – Foreign LanguageLanguage Read Listen Speak

# Days Lost AGCM Dt AGCM Elig DtPVT PV2 PFC SPC - CPL

DORSGT SSG SFC MSG - 1SG

DORDOR SGM - CSM

SECTION VII – CIVILIAN EducationLevel Completed YrDESGInstit tion Yr

Religion

Marital Status Spouse Birthplace/Citz

PULHES Height/Weight

EFMP Dt #Cmd SponsoredPh i l C t APFT Dt P/F Score

Bonus MOSBonus Enlist Elig Dt Technical Certification

Number Of Semester Hours Completed

yDLABSECTION VI – Military Education

MEL/MESCourse Year

Date Dependents Arrived OSPMOS SQISMOS PDSI/YRMO

ASI

Promotion Points/YRMOPrev Promotion Points/YRMOProm Seq# Prom Select DtP i MOS

Institution Yr

Institution YrDiscipline

Course Name Dt Certified Dt Expires

SECTION VIII Awards and Decorations

Physical Category APFT Dt P/F Score

Last Physical Exam MMRB Results/Dt

Home of Record

Mailing Address

Mil Spouse SSN/MPC

Discipline

ACH

TECH

Promotion MOSASVAB Test # / Dt /GT ELEC FOODADMIN FA COMMOCMBT MECH MAINTDelay Separation ReasonAEA / DtFlag Code Flag Start Dt Flag Expiration Dt

SECTION VIII – Awards and Decorations Mil Spouse SSN/MPCSvc Comp / DoDEmergency Data Verified Date

SECTION X - RemarksHIV YRMORGMT AFLDate Last Photo

Correspondence CRS Total # HrsDate of Loss Date of Last PCS Date of Last NCOERSECTION IX – Assignment InformationASGT FROM MO UNIT NO ORGANIZATION STATION LOC COMD DUTY TITLE DMOS ASI LANG

BMQ

For Official Use Only

Privacy Act Data In Accordance With Privacy Act of 1974 Dispose of this Properly

JSCM 1ARCOM 2AAM 5JMUA 1AGCM 2NDSM 1ACM-CS 1ICM-CS 1GWTEM 1GWTSM 1NOPDR 3ASR 1OSR 2ARCOT 1AFRMM 1NATOMDL 1COA 3

CAB 1MQBM-R 1

PROJCurrent 20150122 WJWRC0 0003FASQD FT HOOD US FC FIRE CONTROL SGT 13D3O 00

1st Prev 20120523 WA0UAA 0017FAFIRES BDE JBLM LEWI US FC FIRE CONTROL SGT 13D2O 002nd Prev 20110216 WA0UAA 0017FAFIRES BDE JBLM LEWI US FC FIRE CONTROL SGT 13D3O 2S3rd Prev 20110101 WA0UAA 0017FAFIRES BDE JBLM LEWI US FC FIRE CONTROL SGT 13D2O 004th Prev 20100628 WA0UAA 0017FAFIRES BDE JBLM LEWI US FC FIRE CONTROL SGT 13D2O 005th Prev 20090724 0 WA0UHD 0017FAHOME DETACHM FT LEWIS US FC MAIL ROOM CLERK 13D1O 00 YY6th Prev 20090601 1 WA0UAA 0017FABDE FT LEWIS US FC S3 CLERK 13D1O 00 YY7th Prev 20090428 2 WA0U01 0017FABDE REPL FT LEWIS US FC S3 CLERK 13D1O 00 YY8th Prev 20090216 2 WAT4A0 0003HQCO A FT HOOD US FC FATDS SPECIALIST 13D1O 00 YY9th Prev 20060923 41 WAT4AA 0003HQCORPS FT HOOD US FC FATDS SPECIALIST 13D1O 00 YY

10th Prev 20060719 3 WC7UT1 0003FA FSE FT HOOD US FC FATDS SPECIALIST 13D2O 00 YY11th Prev 20030301 36 WQLVB0 BTRY B, 1/487TH FA WAHIAWA US FC FDC 13D1O 00 YY12th Prev 20030201 2 W2NTA0 BTRY A 1BN 22FA TR FT SILL US TC AIT 13D1O 00 YY13th Prev 20000509 24 W8HWAA US FORCES KOREA SUPPOR FT SHAFTE US FC IMO 25B1O 00 YY14th Prev 20000110 4 W0U5AA COF 369SIGBN 15SIGBDE FT GORDON US TC AIT 25B1O 00 YY15th Prev 19991008 3 W0U67A 120TH AG BATTALION RECECTION FT JACKSO US TC BASIC TRAINING 25B1O 00 YY16th Prev17th Prev18th Prev19th Prev20th Prev21st Prev

22nd Prev23rd Prev24th Prev

TRCMDS CPOSCD TRCUAD FYCAL________________________________________________________

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ASCOC3 - PHYSICAL LIMITATIONSK3 - INSTRUCTOR VOLUNTEERK6 - ACTIVE COMPONENT/RESERVE COMPONENT ADVISOR VOLUNTEERV1 - RECRUITING DUTY PREFERRED