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20. Chronological statement of service in the Army, Navy, Marine Corps, including service as a cadet at U.S. Military or Naval Academy, National Naval Volunteers, National Guard in Federal service, as a Reserve officer on active duty, or at military training camps, or as a contract surgeon serving full time, or as a student in the C.M.T.C. or R.O.T.C., Basic Course, Advanced Course, and Advanced Course camp, giving inclusive dates for each by day, month, and year.

[[7 column table]]
| From | To | Station | Grade | Organization | Duty | Full name and grade of immediate commanding officer |

21. Were you ever rejected for any branch of the military service or for the R.O.T.C. or C.M.T.C?

MILITARY SERVICE OTHER THAN ABOVE

22. Service in Officers' Reserve Corps (inactive); National Guard in the United States; Enlisted Reserve Corps (inactive); Naval or Marine Corps Reserve Forces (inactive); National Guard or Naval Militia not in Federal service, or in military or naval forces of foreign countries: 

23. Prior service in Coast Guard, Public Health Service, or Coast and Geodetic Survey. Give dates and nature of service.

REMARKS.-State any other information you may desire to submit for consideration:
(Signature - Sign all names in full) (First name) (Middle name) (Last name)
(Name typed)

INSTRUCTIONS
1. Fill out on typewriter, if practicable; if not, print proper names and write clearly. This form must be executed IN DUPLICATE and both copies forwarded through the corps area or department commander to the Adjutant General. EACH COPY MUST BE SIGNED.

2. Applications will be accompanied by a Report of Physical Examination (W.D., A.G.O. Form No. 63) which may be obtained from any military post or station. Physical examination should preferably be by a medical officer of the Regular Army, Officers' Reserve Corps, National Guard, or Public Health Service. If applicant desires, the examination may be made by a reputable private physician.

3. If the applicant is in the military service, application will be forwarded through military channels.

4. If appointment is sought with a view to assignment to a particular unit of the Organized Reserves, that fact will be stated under "Remarks."

5. Under "Remarks" make appropriate explanation, when other allotted spaces are insufficient, and any statement you may wish to make with regard to your preference for duty and any recommendation which you may have received for promotion, giving full name and grade of recommending officer.

6. Under "Chronological Statement of Service" state duty specifically, as "regimental adjutant," "company commander," etc., NOT in general terms, as "regimental duty," "staff duty," etc.

3-7585
U.S. GOVERNMENT PRINTING OFFICE

Transcription Notes:
Blank form.