Form Cg-4887 - Auxiliary Operational Specialty Course Examination Request/transmittal Form - Department Of Homeland Security

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DEPARTMENT OF
DEPARTMENT OF
DATE
(Month, Day, Year)
DEPAR TMENT OF
AUXILIARY OPERATIONAL SPECIALTY COURSE EXAMINATION
HOMELAND SECURITY
HOMELAND SECURITY
TRANSPOR TATION
US COAST GUARD
US COAST GUARD
U. S. COAST GUARD
REQUEST/TRANSMITTAL FORM
CG-4887 (08-10) ANSC 7026
CG-4887 (08-10) ANSC 7026
CG-4887 (1-02)
ANSC# 7026
INSTRUCTIONS:
1. Submit original and 2 copies to Director of Auxiliary
2. Form may be completed with ball point pen. Please print.
HOW MANY TIMES
FOR DIRAUX
HAS APPLICANT
NAME OF EXAMINATION
USE ONLY
TAKEN AN
MEMBER ID
LAST NAME
FIRST NAME
INITIAL
REQUESTED
EXAM IN THIS
EXAMINATION
SUBJECT
SERIAL NO.
1. It is requested that the OSC exam for the above listed members be administered on _______________ ,
20 ____ .
2. For those members who have taken and failed a previous examination in the same subject, the required time will have
passed by the date of administration requested above.
3. Arrangements for conducting the examinations may be made by contacting the Auxiliarist whose name, address and
telephone number is listed below.
Name __________________________________________________________
Address _______________________________________________________
Telephone ___________________________________________________
____________________________________________________________
Signature of FSO-MT or FC
FIRST ENDORSEMENT
Date _____________________________________________
From:
To:
1. You are requested to administer the enclosed examinations in accordance with the instructions on the reverse side of
this form.
_____________________________________________________
Signature of Director of Auxiliary
SECOND ENDORSEMENT
Date ____________________________________________
From:
To:
1. The examinations were administered on _____________ 2 0 _____ at ________________________________________________________
by me in accordance with the instructions on the reverse of this form. Those examinations which were not administered
are: (1) indicated by an asterisk (*) by the serial number listed above, (2) returned unopened, and (3) were not
administered for the following reason:
________________________________________________________
Signature of Proctor
CLICK TO CLEAR ALL DATA
Previous edition may be used until supplies are exhausted

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