[104-10129-10002.pdf — page 7]
# SECTION X## MILITARY SERVICE1.  ARE YOU REGISTERED FOR THE DRAFT UNDER THE UNIVERSAL MILITARY TRAINING AND SERVICE ACT OF 1948 (As amended)    *   YES    *   NO2.  SELECTIVE SERVICE CLASSIFICATION    4-F3.  SELECTIVE SERVICE NO.    16-45-28-534.  IF DEFERRED, GIVE REASONDIABETES MELLITUS5.  LOCAL DRAFT BOARD NO. OR DESIGNATION AND ADDRESS    N°45, Orlean Parish, New Orleans, LA.## 2. MILITARY SERVICE RECORD1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP| CHECK (X) AS APPROPRIATE | ARMY | NAVY | MARINE CORPS | AIR FORCE | COAST GUARD | MERCHANT MARINE | NATIONAL AIR GUARD | NATIONAL AIR GUARD | FOREIGN ORGAN. OR MIL. SERVICE (Specify) || ------------------------ | ---- | ---- | ------------ | --------- | ----------- | --------------- | ------------------ | ------------------ | ---------------------------------------- || HAVE SERVED              |      |      |              |           |             |                 |                    |                    |                                          || NOW SERVING              |      |      |              |           |             |                 |                    |                    |                                          |2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S)3. DATE SEPARATED FROM EXTENDED ACTIVE DUTY (Past service) 4. TOTAL LENGTH OF EXTENDED ACTIVE DUTY IN U.S. ARMED FORCES (Past and current service)5. DATE ENTERED ACTIVE DUTYPAST SERVICECURRENT SERVICE6. TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY ORGANIZATION7. RANK, GRADE OR RATEPAST SERVICECURRENT SERVICE8. SERVICE, SERIAL OR FILE NUMBER (If now serving, provide current number)9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLEPAST SERVICECURRENT SERVICE10. SECONDARY MIL. OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLEPAST SERVICECURRENT SERVICE11. BRIEF DESCRIPTION OF MILITARY DUTIES (Indicate whether applicable to past or current service)12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY| HONORABLE DISCHARGE      | RETIREMENT FOR SERVICE             | UNDUE HARDSHIPS || ------------------------ | ---------------------------------- | --------------- || RELEASE TO INACTIVE DUTY | RETIREMENT FOR COMBAT DISABILITY   |                 || RETIREMENT FOR AGE       | RETIREMENT FOR PHYSICAL DISABILITY |                 ||                          | OTHER:                             |                 |13. CHECK (X) COMPONENT IN WHICH YOU SERVED| REGULAR | RESERVE (Including the National and Air National Guard) | OTHER (Including AUS) || ------- | ------------------------------------------------------- | --------------------- |### 3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS1.  DO YOU NOW HAVE RESERVE STATUS?    *   YES    *   NO2.  ARE YOU NOW A MEMBER OF THE NAT'L. GRD. OR AIR NAT'L. GRD.?    *   YES    *   NO3.  ARE YOU NOW A MEMBER OF THE ROTC?    *   YES    *   NO4. IF YOU HAVE ANSWERED "YES" TO ITEMS 1, 2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW| ARMY | NAVY | MARINE CORPS | AIR FORCE | NATIONAL GUARD | COAST GUARD | ARMY ROTC | NAVY ROTC | INDICATE ROTC CATEGORY NUMBER | AIR FORCE ROTC || ---- | ---- | ------------ | --------- | -------------- | ----------- | --------- | --------- | ----------------------------- | -------------- ||      |      |              |           |                |             |           |           |                               |                |5. CURRENT RANK, GRADE OR RATE6. DATE OF APPOINTMENT IN CURRENT RANK7. EXPIRATION DATE OF CURRENT RESERVE OBLIGATION8. CHECK (X) CURRENT RESERVE CATEGORY| READY RESERVE | STANDBY (Active) | STANDBY (Inactive) | RETIRED || ------------- | ---------------- | ------------------ | ------- |9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLE10. SECONDARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Designator) AND TITLE11. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES12. ARE YOU CURRENTLY ASSIGNED OR ATTACHED TO A RESERVE, NAT'L. GUARD OR ROTC TRAINING UNIT    *   YES    *   NO13. IF YOU HAVE ANSWERED "YES" TO ITEM 12, GIVE UNIT OR AGENCY AND ADDRESS14. HAVE YOU A MILITARY MOBILIZATION ASSIGNMENT?    *   YES    *   NO15. IF YOU HAVE ANSWERED "YES" TO ITEM 14, GIVE UNIT OR AGENCY AND ADDRESS16. INDICATE TOTAL MILITARY SERVICE FOR LONGEVITY PURPOSES INCLUDING ACTIVE AND INACTIVE DUTYYEARSNAMONTHSNA17. WHERE ARE YOUR SERVICE RECORDS KEPT?