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00 (808)433-8575 (808)433-1498 (808)433-2737 First Name Marital Status: MI Medical Profile: Y N FAX FAX FAX FAX 433-8578 433-8578 433-1466 433-3339 Rank: Command Phone#: Unit Phone #: DOB: SSN: MOS: GT Score: Clearance: None Secret Flight Top Secret Status: Y N DEROS Time in Unit: Yrs: Date: Time in Hawaii: Yrs: Time in Service: Yrs: 1. PURPOSE OF REFERRAL: (Check One) Emergency Evaluation Commander: Unit: Current Job: Personnel Reliability Program(PGM): Y N Months:.

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