Dd Form 4/1 - Enlistment/reenlistment Document Armed Forces Of The United States - 2001 Page 4
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4NAME OF ENLISTEE/REENLISTEE (Last, First, Middle)
SOCIAL SECURITY NO. OF ENLISTEE/REENLISTEE
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
(list branch of service)
years and
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
a. This enlistee is discharged from the Reserve Component shown in item 8 and is accepted for enlistment in the
Regular 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
I,
defend 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
b. DATE SIGNED
(YYYYMMDD)
23. ENLISTMENT OFFICER CERTIFICATION
a. The above oath was administered, subscribed, and duly sworn to (or affirmed) before me this date.
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)
DD FORM 4/3, JAN 2001
PREVIOUS EDITION MAY BE USED.
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