Navy Occupation or Other status:
Please select from this list...
Aviation Boatswain's Mate
Air Sea Rescue (All branches)
Air Traffic Controller
Aviation Machinist's Mate
Aviation Electronics Mate
Aerographer's Mate
Aviation Storekeeper
Aviation Structural Mechanic
Aviation Ordnanceman
Aviation Support Equipment Technician
Aviation Electronics Technician
Aviation Warfare Systems Operator
Aviation Maintenance Administrationman
Boatswain's Mate
Boiler Technician
Builder
Construction (Seabee)
Coxswain
Construction Mechanic
Crew Blue (Submarine)
Crew Gold (Submarine)
Cryptologic Technician
Damage Controlman
Disbursing Clerk
Data Processing Techncian
Data Systems Technician
Dental Technician
Deterrent Patrol
Diver, Scuba
Diver, 1st Class
Diver, 2nd Class
Diver, Master
Diver, Combatant
Diver, Medical
Draftsman
Engineering Aide
Electrician's Mate
Electronic Warfare System Tech
Engineman
Enlisted Surface Warfare Spec [ESWS]
Equipment Operator
Electricians Mate
Electronics Technician
Electronics Warfare Technician
Fire Controlman
Fire Control Technician
Gunner's Mate
Gas Turbine System Technician*
Hospital Corpsman
Hull Maintenance Technician
Illustrator (Draftsman)
Interior Communications Electrician
Instrumentman
Intelligence Specialist
Journalist
Lithographer
Legalman
Machine Accountant
Molder
Machinist's Mate
Mineman
Machinery Repairman
Machinery Technician
Mess Management Specialist
Missile Technician
Musician
Navy Counselor
Opticalman
Ocean Systems Technician
Operations Specialist
Photographer's Mate
Patternmaker Notes
Personnelman
Aircrew Survival Equipmentman
Quartermaster
Radarman
Radioman
Religious Program Specialist
Seabee
Seabee Combat Warfare Specialist
Seaman (E-3 only)
Seaman's Badge (E-3 and above paygrades)
Ships Serviceman
Storekeeper
Signalman
Sonar Technician
Steelworker
Submarine Service
Surface Warfare Specialist (Enlisted or Officer)
Torpedoman
Utilitiesman
Watertender
Yeoman
or Occupation or Other Service Activity not listed above (DO NOT ABBREVIATE: )
Recipient's LAST Name (as it appears on the Report of Separation) :
FIRST Name (as it appears on the Report of Separation) :
MIDDLE name (as it appears on the Report of Separation) :
Title (Must appear on military documentation): Jr
Sr
II
III
IV
Is this veteran currently living, deceased or KIA:
LIVING
DECEASED
KILLED IN ACTION
Rank/Rating:
I have not moved. My current address info is on file from a previous application
Address:
City:
State:
ZipCode:
Phone (NO SPACES OR DASHES ):
Your full and complete contact email address:PLEASE Do Not Use A GMAIL.COM Address Due To GMAIL Server Problems
SERVICE NUMBER:
Enter the veteran's FIRST FOUR DIGITS ONLY (Do Not enter any alphabet letters. Numbers only. )
Enter the SECOND FOUR (or remaining) DIGITS ONLY
What is the name of the military installation where professional training was received:
What is the date professional training was completed:
If you are sending a Check or Money Order please indicate: