MILITARY STATUS QUESTIONNAIRE

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP67-00059A000300100022-3
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 22, 2016
• Document Release Date: February 2, 2012
• Sequence Number: 22
• Publication Date: January 1, 2000
• Content Type: FORM

THIS DATE
MILITARY SUS QUESTIONNAIRE
NAME (PRINT) (Last) (Middle) (First)
BIRTH DATE (Day) (Month) (Year)
SEX MALE
RACE
CODE MARITAL STATUS = (3) WIDOWED (5) SEPARATED
FEMALE
I1) S111LE
(2) MARRIED Q (4) DIVORCED
NO. OF DEPENDENTS
AGENCY ASSIGNMENT
(INCLUDE WIFE)
OFFICE
DIVISION
CODE
POSITION OR TITLE
GRADE
CODE
M.A.tt~.s i -t t
PRESENT DRAFT STATUS
(A) HAVE YOU REGISTERED FOR DRAFTY (1) YES (2) NO O
(B) IF YES, CHECK YOUR PRESENT DRAFT CLASSIFICATION BELOW
1A AVAILABLE FOR MILITARY SERVICE. AGES 18-26 4B OFFICIAL DEFERRED BY LAW.
]AO CONSCIENTPOUS OBJECTOR, BUT AVAILABLE FOR NON-COMBATANT 4C ALIEN.
DUTY. 4D MINISTER OF RELIGION OR DIVINITY STUDENT.
1C MEMBER OF ANY ACTIVE BRANCH OF MILITARY SERV ICE. MUST IIE CONSC IENTIOUS OBJECTOR - OPPOSED TO BOTH COMBATANT
BE ON FULL DUTY. AND NON-COMBATANT SERV ICE.
ID MEMBER OF ANY RESERVE COMPONENT OF MILITARY SERVICE. [[~ 4F PHYSICALLY OR OTHERWISE UNFIT FOR SERVICE.
CANNOT BE CALLED BY DRAFT BOARDS. CALLED ONLY BY 5A MAN WHO HAS ATTAINED TWENTY-SIXTH BIRTHDAY. NOT
MILITARY SERVICE CONCERNED. LIABLE TO INDUCTION UNDER PRESENT ACT.
2A DEFERRED ON ACCOUNT OF OCCUPATION.
2C DEFERRED FOR AGRICULTURAL OCCUPATION.
3A MAN HAS DEPENDENTS.
LOCAL DRAFT BOARD
4A REGISTRANT WHO HAS COMPLETED SUFFICIENT SERVICE IN
NO.
NAME
WORLD WAR II TO BE CLASSIFIED AS A VETERAN (NINETY DAYS
SERVICE DURING FIGHTING WAR OR ONE YEAR AFTER V-J DAY). ADDRESS (Street and No.)
SOLE SURVIVING SON IN FAMILY. IFA FAMILY HAD TWO SONS
IN A WAR AND ONE WAS KILLED, THE SOLE SURVIVING SON COME
IN THIS CATEGORY.
r The remainder of this form will be filled out only by personnel who have performed duty
.
L in any of the U.S. Armed Services, Merchant Marine or any foreign military organization
SERVICE RECORD
1. CHECK ORGANIZATIONS IN WHICH YOU HAVE SERVED:
(1) ARMY (4) AIR FORCE l J (1) NATIONAL GUARD
(2) NAVY (5) COAST GUARD (8) FOREIGN MILITARY ORGANIZATION
(3) MARINE CORPS II (6) MERCHANT MARINE 11
2. LENGTH OF ACTIVE DUTY IN THE U.S. ARMED SERVICES (INCLUDING TRAINING TOURS)
YEARS MONTHS
(1) WORLD WAR I AND ALL PR IOR DUTY - - - - - - - - - - - - - - - - -
(2) BETWEEN WORLD WAR I AND WORLD WAR II - - - - - - - - - - - - - - -
(3) WORLD WAR 1 1 - - - - - -' - - - - - - - - - - - - - - - -
(4) SINCE WORLD WAR II-- - - - - - - - - - - - - - - - - - - -
ACTIVE DUTY TO DATE (TOTAL)
3. FURNISH THE FOLLOWING DATA AS TO YOUR COMMISSIONED OR ENLISTMENT STATUS UPON SEPARATION:
(1) COMMISSIONED OR (2) ENLISTED
NAME OF SERVICE
RANK, GRADE OR RATING ARM, BRANCH OR CORPS
LAST SERIAL, SERVICE OR FILE NO.
DO NOT WRITE IN SPACES BELOW
FORM 950 h0. 3 Declassified and Approved For Release 2012/02/02 : CIA-RDP67-00059AO00300100022-3 ever)
AUG ~uG
Declassified and Approved For Release 2012/02/02 : CIA-RDP67-00059AO00300100022-3
 Declassified and Approved For Release 2012/02/02 : CIA-RDP67-00059A000300100022-3
C-J
RETIREMENT FOR AGE
RETIREMENT FOR SERVICE
RETIREMENT FOR COMBAT DISABILITY
RETIREMENT FOR OTHER PHYSICAL DISABILITY
SEPARATED (POINTS, CATEGORY, ETC.)
RELEASE ESSENTIAL TO NATIONAL HEALTH, SAFETY OR INTEREST
RELEASE BECAUSE OF UNDUE HARDSHIPS
IF YOUR PRESENT STATUS DIFFERS IN ANY RESPECT FROM THAT STATED IN 3 ABOVE, INDICATE CHANGE ONLY AND DATE OF
CHANGE: . DATE CODES
COMMISSIONED
SERVICE
ARM, BRANCH OR CORPS
. ARE YOU NOW IN THE NATIONAL GUARD? (1) YES 0 (2). NO
(A) IF YES, WHAT UNIT? _
(B) DID YOU ENTER FEDERAL ARMED FORCES THROUGH NATIONAL GUARD? (1) YES
(2) NO
t t
(C) IS YOUR ASSIGNMENT AN ORGANIZED UNIT?, (1) YES
(2) YES-ACTIVE
( 2 ) N O
DO YOU HAVE A MOBILIZATION ASSIGNMENT? (1) YES O (2) NO
(A) IF YES, STATE NAME OF UNIT ORGANIZATION ({'th'
Declassified and Approved For Release 2012/02/02 : CIA-RDP67-00059A000300100022-3