Dd Form 4/1 - Enlistment/reenlistment Document Armed Forces Of The United States - 2007 Page 4

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NAME OF ENLISTEE/REENLISTEE
SOCIAL SECURITY NO. OF ENLISTEE/REENLISTEE
(Last, First, Middle)
F. DISCHARGE FROM/DELAYED ENTRY/ENLISTMENT PROGRAM
20a. I request to be discharged from the Delayed Entry/Enlistment Program (DEP) and enlisted in the Regular Component of the
United States
for a period of
years and
(list branch of service)
weeks. No changes have been made to my enlistment options OR if changes were made they are recorded on
Annex(es)
which replace(s) Annex(es)
.
b. SIGNATURE OF DELAYED ENTRY/ENLISTMENT PROGRAM ENLISTEE
c. DATE SIGNED
(YYYYMMDD)
G. APPROVAL AND ACCEPTANCE BY SERVICE REPRESENTATIVE
21. SERVICE REPRESENTATIVE CERTIFICATION
This enlistee is discharged from the Reserve Component shown in item 8 and is accepted for enlistment in the Regular
a.
Component of the United States
in pay grade
.
(list branch of service)
b. NAME
c. PAY GRADE
d. UNIT/COMMAND NAME
(Last, First, Middle)
e. SIGNATURE
f. DATE SIGNED
g. UNIT/COMMAND ADDRESS
(City, State, ZIP Code)
(YYYYMMDD)
H. CONFIRMATION OF ENLISTMENT OR REENLISTMENT
22a. IN A REGULAR COMPONENT OF THE ARMED FORCES:
, do solemnly swear (or affirm) that I will support and defend
I,
the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same;
and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to
regulations and the Uniform Code of Military Justice. So help me God.
b. SIGNATURE OF ENLISTEE/REENLISTEE
c. DATE SIGNED
(YYYYMMDD)
23. ENLISTMENT OFFICER CERTIFICATION
The above oath was administered, subscribed, and duly sworn to (or affirmed) before me this date.
a.
b. NAME
c. PAY GRADE
d. UNIT/COMMAND NAME
(Last, First, Middle)
e. SIGNATURE
f. DATE SIGNED
g. UNIT/COMMAND ADDRESS
(City, State, ZIP Code)
(YYYYMMDD)
(Initials of Enlistee/Reenlistee)
DD FORM 4/3, OCT 2007
Reset
PREVIOUS EDITION IS OBSOLETE.

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