Personal History Statement Template - North Carolina Criminal Justice Education And Training Standards Commission Page 11

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39. List each tour of active duty where a DD-214 was issued:
From
To
Branch
Unit (Company or Ship)
Location
Mo./Yr.
Mo./Yr.
40. List all duty stations:
From
To
Branch
Unit (Company or Ship)
Location
Mo./Yr.
Mo./Yr.
41. Have you ever received any of the following types of discharge:
Uncharacterized
Yes
No
Honorable
Yes
No
General (Under honorable conditions)
Yes
No
Under other than honorable conditions
Yes
No
Bad Conduct Discharge
Yes
No
Dishonorable Discharge
Yes
No
Dismissal
Yes
No
42. Were you ever court-martialed, tried on charges, or the subject of a summary court, deck court, non-
judicial punishment, captain’s mast, company punishment, article 15, and/or any other disciplinary
action while a member of the military, national guard or reserve unit?
Yes
No If yes, explain what occurred and what type of punishment you received: _____________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
43. List all medals and decorations awarded you during your military service: _____________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
F-3(LE) Rev. 12.2.13
11

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