Application 2-1
Appendix B
a. General Information
(1) Full name: Information Withheld
(2) Social security number: 123-45-6789
(3) Selective service number: No selective service number applicable.
(4) Service address and component: Regular Army, 500th MI Group, Camp Zama, APO AP 96338-5009
(5) Permanent home address: (information withheld)
(6) Name and Address of each school and college attended, with dates and the type of school (public, church, military, commercial, etc.)
AUG 1980-JUNE 1997 Information Withheld (public)
(7) A chronological list of all types of work, other than as a student in school or college, whether for monetary compensation or not. Include the type of work, name and address of employer, and dates for each position.
SEPT 1993-PRESENT Position, Company, City, State ZIP
(8) All former addresses and dates of residence at those addresses.
SEPT 1979-PRESENT Information Withheld
(9) Parent�s name and addresses. Indicate whether they are living or deceased.
(10) Father: (Information Withheld) (living)
(11) Mother: (Information Withheld) (living)
(12) The religious denomination or sect of both parents.
Father: Catholic
Mother: Methodist
(13) Was application made to the Selective Service System (local board) for classification as a conscientious objector before entry into the armed forces?
No previous application for classification as a conscientious objector has been made to the Selective Service System.
(14) Was any previous application made in service for classification as a conscientious objector?
No previous application for classification as a conscientious objector has been made in service.
(15) Whether the person has served less than 180 days in the Armed Forces.
More than 180 days has been served in the Armed Forces.
