Af Form 2030 Usaf Drug And Alcohol Abuse Certificate (Page 2 of 2) in pdf

Af Form 2030 Usaf Drug And Alcohol Abuse Certificate Page 2

WITNESS

I CERTIFY THE ABOVE INDIVIDUAL SIGNED THIS CERTIFICATE OF HIS/HER OWN FREE WILL

DATE

NAME (Last, First, M.I.) AND GRADE OF WITNESS

SIGNATURE

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REMARKS

Specific Drug used:

Method of use:

What effects were produced?

How many times did you take this drug?

Pre-application limited to experimental use of marijuana, unlikey to recur. I waive the use and grant program entry. Member has

been briefed and agrees to abide by Air Force policy regarding the prohibited use of Hemp derivatives.

Program entry is waived. __________CC Initials

Based on the circumstances surrounding your drug usage, I hereby deny a waiver for entrance into the program. As an applicant you

have the right to appeal to HQ AFROTC. __________ CC Initials

INITIALS

SECTION IV. RECERTIFICATION AT TIME OF ENLISTMENT, COMMISSIONING, OR APPOINTMENT

I have read and fully understand all the information on this form.

I hereby state that there has been no change in my status since I originally provided this information on the date on front of this

form.

I hereby certify that I have not used any drug, including marijuana, and that I have not been in any alcohol related abuse incidents,

since I originally completed this form.

DATE

SIGNATURE

NAME (Last, First, M.I.) AND SSN OF APPLICANT

WITNESS

I CERTIFY THE ABOVE INDIVIDUAL SIGNED THIS CERTIFICATE OF HIS/HER OWN FREE WILL

DATE

SIGNATURE

NAME (Last, First, M.I.) AND GRADE OF WITNESS

AF FORM 2030, 20121107

PREVIOUS EDITIONS ARE OBSOLETE

PRIVACY ACT INFORMATION: The information in this form is

FOR OFFICIAL USE ONLY. Protect IAW the Privacy Act of 1974

Af Form 2030 Usaf Drug And Alcohol Abuse Certificate Page 2