MILITARY STATUS QUESTIONAIRE

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-04917A000100020037-9
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: April 29, 1998
• Sequence Number: 37
• Content Type: FORM

Y 9I7A000I 00
ApprovMI LITARY
IO
QNF
TUSSQUE
07'!9 DATE
STA
N
ST
IR
NAME (PRINT) (Last) (Middle) (First)
BIRTH DATE (Day) (Month) (Year)
SEX MALE
RACE
CODE
MARITAL STATUS (1) SIN
(3) WIDOWED (5) SEPARATED
L
FEMALE =
G
E
(2) MARRIED (4) DIVORCED O
NO. OF DEPENDENTS
AGENCY ASSIGNMENT
(INCLUDE WIFE)
OFFICE
DIVISION
CODE
POSITION OR TITLE
GRADE
CODE
PRESENT DRAFT STATUS
(A) HAVE YOU REGISTERED FOR DRAFT? (1) YES 1j (2) NO
(B) IF YES, CHECK YOUR PRESENT DRAFT CLASSIFICATION BELOW:
Q 1A AVAILABLE FOR MILITARY SERVICE. AGES 18-26 4B OFFICIAL DEFERRED BY LAW.
]AO CONSCIENTIOUS OBJECTOR, BUT AVAILABLE FOR NON-COMBATANT >}F 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.
4A REGISTRANT WHO HAS COMPLETED SUFFICIENT SERVICE IN LOCAL DRAFT BOARD
WORLD WAR 11 TO BE CLASSIFIED AS A VETERAN (NINETY DAYS NAME NO.
SERVICE DURING FIGHTING WAR OR ONE YEAR AFTER V-J DAY).
ADDRESS (Street and No.)
SOLE SURVIVING SON IN FAMILY. IF A FAMILY HAD TWO SONS
IN A WAR AND ONE WAS KILLED, THE SOLE SURV IV ING 5ON COME
IN THIS CATEGORY.
The remainder of this form will be filled out only by personnel who have performed duty
[
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 L J (4) AIR FORCE (7) NATIONAL GUARD
(2) NAVY (5) COAST GUARD `-J (8) FOREIGN MILITARY ORGANIZATION
(3) MARINE CORPS I (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 PRIOR DUTY - - - - - - _ - - _ - - - - - _ -
(2) BETWEEN WORLD WAR I AND WORLD WAR 11
(3) WORLD WAR I I - - - - - - - - _ - - - - - - - _ - _ - - - -
(4) S INCE 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 u
NAME OF SERVICE
RANK, GRADE OR RATING
ARM, BRANCH OR CORPS
LAST SERIAL, SERVICE OR FILE NO.
DO NOT WRITE IN SPACES BELOW
Approved For Release 2 01/05/11 : CIA-RDP7 -04917A00010002
037-9
FORM NO
AUG 1950 . 37-82 (over)
 u.
CHECK bA~ vlgd'P& ?teleas 01/05/11: CIA-RDP78-04917A0001 0037-9
(1) I I RETIREMENT FOR AGE
(2) RETIREMENT FOR SERVICE
(3) RETIREMENT FOR COMBAT DISABILITY
(4) RETIREMENT FOR OTHER PHYSICAL DISABILITY
(5) LJ SEPARATED (POINTS, CATEGORY, ETC.)
(6) RELEASE ESSENTIAL TO NATIONAL HEALTH, SAFETY OR INTER
EST
(7) RELEASE BECAUSE OF UNDUE HARDSHIPS
5.
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
RANK, GRADE OR RATING
SERVICE, SERIAL OR FILE NO.
6.
ARE YOU NOW IN THE NATIONAL GUARD? (1) YES (2)
NO
(A) IF YES, WHAT UNIT?
(B) DID YOU ENTER FEDERAL ARMED FORCES THROUGH NATIONAL GUARD?
(1) YES (2)
NO
7.
DO YOU HAVE RESERVE STATUS? (1) YES-INACTIVE (2)
YES-ACTIVE L-J (31
NO C~I
(A) ARE YOU ASSIGNED TO AN AGENCY UNIT? (1) YES
(2) NO
(B) IF NO, WHAT IS YOUR ASSIGNMENT?
(C) IS YOUR ASSIGNMENT AN ORGANIZED UNIT? (1) YES
(2) NO
B.
DO YOU HAVE A MOBILIZATION ASSIGNMENT? (1) YES
(2) NO
(A) IF YES, STATE NAME OF UNIT ORGANIZATION
REMARKS:
Approved For Release 2001/05/11 CIA-RDP78-0
OR
T
E