MEMORANDUM FOR Commander, <<Unit Designation>>, <<Address>>
SUBJECT: Request Classification as a Conscientious Objector (1-0)
I have become a conscientious objector to war in any form. I seek separation from the Army following classification as a conscientious objector (1-0). I understand that until a final decision is made, I am to be employed in duties providing minimal conflict with my beliefs. Further, I understand that I will continue to train except in the study, use, or handling of ammunition, weapons, and munitions.
//original signed//
Encl FIRST M. LAST
1. DA Form 4187, Jan 2000 RANK, USA
2. AR 600-43, Appendix B
(I prepared my entire application before notifying my command in order to show my commitment and resolve, to demonstrate my thorough understanding of the application process, to not subject myself to their deadlines, and to not be brushed-off. Your command has 180 days to process your personnel action to the Department of Army.)
1. THRU 2. THROUGH 3. FROM <<ask your leadership to whom you should address a request for personnel action>>
SECTION 1--PERSONAL IDENTIFICATION
4. NAME 5. RANK/MOS 6. SSN
SECTION 2--DUTY STATUS CHANGE
7. <<I left this section blank.>>
SECTION 3--REQUEST FOR PERSONNEL ACTION
8. OTHER <<Conscientious Objection>> 9. SIGNATURE 10. DATE
SECTION 4--REMARKS
1. Request separation based on Conscientious Objection (1-0).
2. Justification: In accordance with AR 600-43, Appendix B, attached is the required general information, explanation as to training, and an outline of participation in organizations.
3. DEROS: <<date>> BASD: <<date>> ETS <<date>>