Vmet printout web site
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|  Yüklə 45 Kb.
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| SEPARATION/DISCHARGE INTERVIEW SHEET
VMET PRINTOUT WEB SITE: https://www.dmdc.osd.millappj/vmet/index.jsp NAME: ____________________________ RATE: _______ E-MAIL (WORK): ___________________ E-MAIL (PERSONAL) ________________ SSN: ___________________________ DOB: __________________________ NEC: ___________ EAOS: _____________________ DATE OF SEPARATION/DISCHARGE: ___________________ CURRENT COMMAND: _____________________________________________ UIC: __________ WORK PHONE: (757)____________ HOME PHONE: (___) _____________ CELL:( )_____________ ___________________________PERSONAL INFORMATION______________________________ CURRENT LOCAL ADDRESS: APT/ST NO: ____________________________________________ CITY: ____________________________ STATE: ____ ZIP: ________ PH: (____) ____________ SEPARATION ADDRESS: APT/ST NO: ________________________________________________ CITY: ____________________________ STATE: ____ ZIP: ________ PH: (____) ____________ NEAREST RELATIVE (NAME): _____________________________ RELATIONSHIP: _________ ADDRESS: _______________________________________________ PHONE: (____) _____________ _________________________________LEAVE STATUS___________________________________ TERMINAL LEAVE: Y / N NO. OF DAYS: _______ FROM: ______________ TO: ___________ ORDINARY LEAVE: Y /N NO. OF DAYS: _______ FROM: ______________ TO: ___________ DATES OF LAST PERIOD OF LEAVE TAKEN: FROM: ______________ TO: ___________ FROM: ______________ TO: ___________ ___________________________EDUCATIONAL INFORMATION__________________________ HIGH SCHOOL DIPLOMA OR GED? YES (______) NO (______) ENLISTED UNDER LOAN REPAYMENT PROGRAM _______YES / ______NO HAVE YOU TAKEN THE NAVY-WIDE EXAM? E4 / E5 / E6 DATE OF EXAM: _____________ SGLI: $400,000 $250,000 $200,000 $150,000 $100,000 $50,000 OTHER: __________ _______________________________TRAVEL INFORMATION_____________________________ HOME OF RECORD - CITY: ______________________ STATE: ______ PLACE OF ENTRY INTO ACTIVE DUTY - CITY: ______________________ STATE: ______ PLACE SELECTED FOR TRAVEL ENTITLEMENTS - CITY: _________________ STATE: _____ PLEASE PLACE A CHECK BESIDE ALL MEDALS AND DECORATIONS YOU HAVE RECEIVED DURING YOUR CAREER AND INDICATE THE NUMBER OF AWARDS RECEIVED IN THE BLANK PROVIDED. PLEASE NOTE THAT TO APPEAR ON YOUR DD214 THESE AWARDS MUST BE IN YOUR SERVICE RECORD OR ESR. OTHERWISE YOU WILL HAVE TO PROVIDE PROOF OF HAVING RECEIVED THE AWARD: ( ) MERITORIOUS UNIT COMMENDATION ___ ( ) GOOD CONDUCT MEDAL ___ ( ) NAVY EXPEDITIONARY MEDAL ___ ( ) ARMED FORCES EXPEDITIONARY MEDAL ___
( ) COAST GUARD SPECIAL OPERATION RIBBON ___ ( ) NAVY “E” RIBBON ___ ( ) NAVY FLEET MARINE FORCE RIBBON ___ ( ) NATIONAL DEFENSE SERVICE MEDAL ___ ( ) SOUTHWEST ASIA SERVICE MEDAL ___ ( ) KUWAIT LIBERATION MEDAL (Kuwait) ___ ( ) KUWAIT LIBERATION MEDAL (Saudi Arabia ___ ( ) GLOBAL WAR ON TERRORISM EXPEDITIONARY MEDAL ____ ( ) NATO MEDAL ____ SERVICE MEDAL ____
IN ACCORDANCE WITH MILPERSMAN 1160-040, I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO COMPLETE MY PHYSICAL SCREENING WITHIN 90 DAYS, BUT NOT LESS THAN 30 DAYS PRIOR TO MY EAOS INCIDENT TO MY SEPARATION. A COPY OF PHYSICAL SCREENING (SF 88/93) OR (DD FORM 2807-1 & DD FORM 2808) MUST BE DELIVERED TO COMMAND CAREER COUNSELOR NOT LATER THAN 30 WORKING DAYS BEFORE ACTION. MEMBER’S SIGNATURE: __________________________________________ DATE: ________________ |