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HIP PLACE OF BIRTH DATE OF BIRTH NAME OF SPOUSE (Last, First, Middle) CLEARANCE STATUS (Degree) BASIS CITIZENSHIP PLACE OF BIRTH COMPLETED BY (Agency) DATE COMPLETED PURPOSE FOR REQUESTING LOCAL RECORDS CHECK RESULTS OF COMMAND SCREENING RECORDS CHECKED: OQR/SRB HEALTH RECORD UNIT PUNISHMENT LOG RECORDS SCREENED BY THE COMMAND REFLECT (Check appropriate block): NO DEROGRATORY INFORMATION FOLLOWING INFORMATION: (Signature of Requesting Official) Designed Using FormFlow2.15, HQMC/.

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Keywords relevant to Navmc 10482

  • DEROGRATORY
  • SRB
  • FormFlow2
  • SN
  • mos
  • EF
  • screened
  • EDITIONS
  • citizenship
  • spouse
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