Da Form 61 - Application For Appointment - 1981 Page 2
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424. ARE YOU NOW, OR HAVE YOU EVER BEEN A CONSCIENTIOUS OBJECTOR?
YES
NO (If yes, attach affidavit)
25.
I UNDERSTAND THAT, IF I AM SELECTED FOR APPOINTMENT, I WILL BE EXPECTED TO ACCEPT SUCH ASSIGNMENTS AS ARE IN THE BEST INTEREST OF THE SERVICE
REGARDLESS OF MY MARITAL STATUS AND/OR RESPONSIBILITY FOR DEPENDENTS; AND IT IS MY RESPONSIBILITY TO MAKE APPROPRIATE ARRANGEMENTS FOR THE CARE
OF MY DEPENDENTS SHOULD I BE REQUIRED TO PERFORM DUTY IN AN AREA WHERE DEPENDENTS ARE NOT PERMITTED.
26.
HAVE YOU EVER UNDER EITHER MILITARY OR CIVILIAN LAW BEEN INDICTED OR SUMMONED IN TO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING (Including any
proceedings involving juvenile offenses, article 15, UCMJ, and any court-martial) REGARDLESS OF THE RESULT OF TRIAL, OR CONVICTED, FINED, IMPRISONED, PLACED ON
PROBATION, PAROLED OR PARDONED, OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR
ORDINANCE? (Exclude traffic violations involving a fine or forfeiture of $100 or less).
YES
NO
IF YES, ATTACH REQUEST FOR WAIVER LISTING THE DATE, THE NATURE OF EACH ALLEGED OFFENSE OR VIOLATION, THE NAME AND LOCATION OF
THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER DISPOSITION OF EACH CASE AND FURNISH COPY OF COURT ACTION OR DETAILED STATEMENT IN
AFFIDAVIT FORM AS TO THE OUTCOME OF EACH CASE.
27. ACTIVE MILITARY SERVICE (Indicate tour with each organization separately - show ROTC Camps in Item 39)
d. PRIOR
a. ORGANIZATION
b. DATES (Day, Month, Year)
c. BRANCH/MOS
e. HIGHEST GRADE
SERVICE NO.
(US Armed Forces, USCG, NOAA,
(As appropriate)
AND COMPONENT
FROM
TO
(If applicable)
US Public Health Service, Peace Corps)
f. DATE CURRENT ACTIVE DUTY TOUR TERMINATES
g. DATE OF LAST ADL PROMOTION
28. RESERVE OR NATIONAL GUARD SERVICE (Not on active duty)
a. ORGANIZATION
d. PRIOR
b. DATES (Day, Month, Year)
e. HIGHEST GRADE
c. BRANCH/MOS
(US Armed Forces, USCG, NOAA,
SERVICE NO.
AND COMPONENT
(As appropriate)
FROM
TO
US Public Health Service, Peace Corps)
(If applicable)
29. SOURCE OF CURRENT COMMISSION (If applicable)
30. AWARDS (Do not list theater or service medals)
OTHER
ARNGUS:
OCS
DIRECT APPOINTMENT
USAR:
OCS
ROTC
ROTC (ECP)
ROTC (SMP)
DIRECT APPOINTMENT
31. HAVE YOU EVER APPLIED AND NOT BEEN SELECTED FOR:
a. ROTC
YES
NO
b. OCS
YES
NO
c. APPOINTMENT IN RESERVE COMPONENT (USAR/ARNG)
YES
NO
d. APPOINTMENT IN REGULAR ARMY
YES
NO
AS A WARRANT OFFICER
AS A WARRANT OFFICER
AS A COMMISSIONED OFFICER
AS A COMMISSIONED OFFICER
e. IF ANSWER IS "YES", EXPLAIN FULLY
32.
ARE YOU NOW OR HAVE YOU EVER BEEN IN THE MILITARY SERVICE OF OR BEEN EMPLOYED BY A FOREIGN GOVERNMENT
(If yes, give dates, country and type of service or
employment)
33.
HAVE YOU EVER RESIGNED OR BEEN ASKED TO RESIGN IN LIEU OF ELIMINATION PROCEEDINGS; BEEN DISCHARGED IN LIEU OF ELIMINATION, FURLOUGHED
(other than
regular furlough or leave),
OR PLACED ON INACTIVE STATUS WHILE SERVING IN THE US ARMED FORCES; OR, HAVE YOU EVER RESIGNED OR BEEN ASKED TO RESIGN FROM
A POSITION WHILE IN PRIVATE OR GOVERNMENT EMPLOYMENT?
(If yes, state circumstances; if more space is required, continue on separate sheet).
YES
NO
APD LC v2.01ES
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