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Note: Some of this info is on the DD 214. However, in most cases it is very time consuming to decipher the many variations of the DD 214. You assistance is appreciated. |
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Name |
____________________________________________________________ |
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First |
Middle |
Last |
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Address |
___________________________________________________________ |
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__________________________________________________ |
_________o CA |
_____________ |
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City |
State |
Zip |
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Telephone |
(___) - _______ |
(___)-_________ |
(___)-________ |
(___)-_________ |
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Home |
Business |
Cell |
Fax |
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Occupation |
____________________________________________________________ |
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Military |
_____________ |
_____________ |
_____________ |
_____________ |
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Branch |
Rank |
Rate/MOS |
Serial No. |
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____/____/____ |
____/____/____ |
________o HON |
_______________ |
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Date of Entry |
Date Discharge |
Type Discharge |
Era |
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_____________________________ |
_____________ |
_____________ |
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Service Disability |
C. Number |
Blood Type |
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Personal |
____/____/____ |
_____________ |
_________o CA |
_______o USA |
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Date of Birth |
City |
State |
Country |
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_____________________________ |
_____________ |
_____________ |
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Next of Kin |
Relationship |
No. Dependents |
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___________________________________________________________o Same |
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Next of Kin Address |
DD-214 included |
o Yes |
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___________________________________ ____/____/____ |
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| Click here to print this page |
Signature of Applicant Date Email: __________________@_________________________ |
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We, the undersigned members of this Post 184, do hereby certify that we have personally examined this applicant's Honorable discharge and have verified their qualifications for membership in American Legion South Bay Post 184. |
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1.________________________________________ |
2. __________________________________ |