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42 Cards in this Set

  • Front
  • Back
This goes in block 1.
What is the member's name?
These three elements go in block 2.
What is department, component, and branch?

i.e., NAVY - USNR
This goes in block 3.
What is the social security number?
This goes in block 4a.
What is grade, rank, or rate?

i.e., PS3
This goes in block 4b.
What is paygrade?

i.e., E4
This goes in block 5.
What is date of birth?
This goes in block 6.
What is reserve obligation terminal date?
This goes in block 7a.
What is place of entry into active duty?
This goes in block 7b.
What is the Home Of Record at time of entry?
This goes in block 8a.
What is the last duty assignment and major command?
This goes in block 8b.
What is the station where separted?
This goes in block 9.
What is the command to which transferred?
This goes in block 10.
What is the Servicemen's Group Life Insurance Coverage?
This goes in block 11.
What is the primary specialty?
This goes in block 12a.
What is date entered active duty this period?
This goes in block 12b.
What is separation date this period?
This goes in block 12c.
What is net active service this period?
This goes in block 12d.
What is total prior active service?
This goes in block 12e.
What is total prior inactive service?
This goes in block 12f.
What is foreign service?
This goes in block 12g.
What is sea service?
This goes in block 12h.
What is effective date of pay grade?
This goes in block 13.
What are decorations, medals, badges, citations, and campaign ribbons awarded or authorized?
This goes in block 14.
What is military education?
The "x" in block 15a indicates this.
What is whether they contributed to the post Vietnam era veterans' educational assistance program?
The "x" in block 15b indicates this.
What is whether they are a high school graduate or equivalent?
This goes in block 16.
What is days of accrued leave paid?
And "x" in block 17 indicates this.
What is whether they completed all needed dental services within 90 days of separation?
These goes in block 18.
What are remarks?
This goes in block 19a.
What is mailing address after separation?
This goes in block 19b.
What is the nearest relative?
An "x" in block 20 indicates this.
What is whether the member would like a copy sent to the Department Of Veterans Affairs?
This goes in block 21.
What is the signature of the member?
These 4 items go in block 22.
What is the typed name, grade, title, and signature of the official authorized to sign?
This goes in block 23.
What is type of separation?

i.e., discharge, released from active duty, etc.
This goes in block 24.
What is character of service?
This goes in block 25.
What is separation authority?
This goes in block 26.
What is separation code?
This goes in block 27.
What is re-entry code?
This goes in block 28.
What is narrative reason for separation?
These go in block 29.
What are the dates of time lost during this period?
The member's initials in block 30 indicate this.
What is that they would like to receive copy 4?