Fillable Printable Application For Voluntary Retirement
Fillable Printable Application For Voluntary Retirement
Application For Voluntary Retirement
APPLICATION FOR VOLUNTARY RETIREMENT
For use of this form, see AR 635-200; the proponent agency is G-1.
12.
DATE
16. TOTAL ACTIVE SERVICE CREDITABLE FOR RETIREMENT
MEDAL OF HONOR
SOLDIERS MEDAL
DISTINGUISHED SERVICE CROSS
13. AWARDS
ELIGIBILITY DATE
(TO BE COMPLETED ONLY BY RESERVE OFFICERS SERVING ON ACTIVE DUTY IN ENLISTED STATUS)
8. DESIRE RETIREMENT AT CURRENT OVERSEA ASSIGNMENT
Title 10, United States Code, Chapters 61, 63 and 67.
To initiate necessary administrative action in regard to voluntary requests for retirement.
Data contained on the form is used to complete administrative actions incident to retirement.
10. NON-CONUS PERSONNEL STATIONED OVERSEAS DESIRE
RETIREMENT
home of selection) (Include ZIP Code)
DATA REQUIRED BY THE PRIVACY ACT
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
2. SSN 3. ETS 4. DESIRED RETIREMENT
DATE
AND MOS
7. UNIT OF ASSIGNMENT - DUTY STATION - MAJOR COMMAND
YES NO NOT APPLICABLE
HOR
11. REQUEST TRANSFER TO RETIRED RESERVE IN THE FOLLOWING STATUS
COMMISSIONED WARRANT OFFICER ENLISTED
RETIRED ACTIVE
14. CHRONOLOGICAL DATES OF MILITARY SERVICE
TIME
LOST
ACTIVE FEDERAL
SERVICE
INACTIVE SERVICE
17. TOTAL INACTIVE SERVICE CREDITABLE FOR BASIC PAY ONLY
DA FORM 2339, JUN 1983
EDITION OF APR 78 WILL BE USED UNTIL EXHAUSTED.
6. HIGHEST GRADE SERVED ON ACTIVE DUTY AND BRANCH OF
SERVICE
APD LC v4.02ES
CONUS CURRENT OVERSEAS STATION
NONENAVY CROSS
DISTINGUISHED FLYING CROSS OR EQUIVALENT NAVY DECORATION
ENL. WO.
COM
(Indicate)
COM-
PONENT
FROM TOTAL TOTAL
DAYS
TO
YEAR MO DAY YEAR MO DAY YEARS MONTHS DAYS YEARS MONTHS DAYS
18. TOTAL SERVICE FOR BASIC PAY PURPOSES
(Item 16 + 17)
(Do not include time lost)
15. TOTAL TIME LOST (If no time lost, enter "None")
b. GRADE & PROMOTION
(CONUS Residents only)
9. MAIL ADDRESS UPON RETIREMENT (Will not be considered as
TO: (Include ZIP Code) THRU: (Include ZIP Code)
SECTION I - (TO BE COMPLETED BY ALL APPLICANTS)
1. NAME (Last, First, Middle)
5. CURRENT GRADE, PAY GRADE,
(Effective date of promotion)
a. RESERVE COMMISSIONED STATUS c. BRANCH
Disclosure is voluntary. However, failure to disclose required information may result in service member not
being considered for voluntary retirement.
(Enlistment and Discharge dates and change in status from active to
inactive service and vice versa.) (Para 12-13, AR 635-200)
DATE
on
indicate reason and expiration date in Remarks)
20. RECOMMEND
29. DATE MEMBERS OF UNIT WERE NOTIFIED OF UNIT ALERT
IS NOT SUBMITTING REQUEST IN LIEU OF ELIMINATION OR FURTHER ELIMINATION PROCEEDINGS.
- (TO BE COMPLETED BY COMMANDER HAVING CUSTODY OF PERSONNEL RECORDS)
19. CONUS LOCATION OF CHOICE TRANSFER ACTIVITY
I ELECT TO BE PROCESSED FOR RETIREMENT AT:
I DO NOT ELECT TO BE PROCESSED FOR RETIREMENT AT A CONUS LOCATION OF CHOICE.
I am familiar with the provisions of AR 635-200 pertaining to
SIGNATURE OF APPLICANT
SECTION II
APPROVAL
22. APPLICANT IS
(If "YES" application must be attached to board proceedings.)
23. APPLICANT HAS 24. THIS ACTION IS IS NOT
MPRJ AGPERSCEN:
(If other than MPRJ, attach verification)
DATE: NOT APPLICABLE
DATE: NOT APPLICABLE
30. STATEMENT OF UNDERSTANDING
(Signature of member)
TYPED NAME, GRADE AND TITLE OF COMMANDER/PERSONNEL
OFFICER
SIGNATURE
has requested and had approved days of transitional leave
(DDALV) to be taken in conjunction with the requested retirement action. This leave will begin
APD LC v4.02ES
DA FORM 2339, JUN 1983
FROM: (Include ZIP Code)TO: (Include ZIP Code)
27. DATE APPLICANT OR DEPENDENT ARRIVED IN OVERSEA COMMAND
(Whichever is later - specify applicant or dependent)
DISAPPROVAL (Indicate reason(s) in Remarks)
28. DATE OF RECEIPT OF ALERT (Nomination for assignment) OR ASSIGNMENT ORDERS (Not applicable for unit alert - see Item 31)
26. DATE APPLICANT ARRIVED AT PRESENT ASSIGNMENT
(Other than Oversea Command - see Item 27)
25. SERVICE SHOWN
(Items 14-18)
HAS BEEN VERIFIED AS CORRECT BY:
OTHER
(Specify)
31. REMARKS
(Continue on additional sheet if necessary)
HAS NOT INCURRED A SERVICE OBLIGATION
(If "HAS"
21. AUTHORIZED TRANSFER ACTIVITY
(If other than current installation, specify)
I ATTEST THAT I HAVE BEEN COUNSELED AS SPECIFIED BY PARAGRAPH 2-18, AR 635-10. I ALSO FULLY UNDERSTAND
THE PROVISIONS OF SECTION V, CHAPTER 2, AR 635-10 CONCERNING MY ENTITLEMENTS PERTAINING TO PER DIEM,
TRAVEL AND TRANSPORTATION ALLOWANCES, BASED ON MY RETIREMENT AT A CONUS LOCATION OF CHOICE.
withdrawal of this application for retirement once it has been
accepted by the retirement approval authority.
IN CONTRAVENTION WITH
AR 600-31
1. I have read Section V, Chapter 12, AR 635-200. I understand that I must undergo a medical examination prior to my retirement. I
am responsible for insuring that the examination is scheduled not earlier than 4 months, nor later than 1 month prior to my approved
retirement date (subject examination to be arranged through coordination with my unit of assignment). I am aware that the purpose of
this examination is to provide a better health assessment of me and, in particular, to continue cardiovascular attention, to record as
accurately as possible, my state of health on retirement and to protect my interests and those of the Government. I also understand
that my retirement will take effect on the requested date and that I will not be held on active duty to complete this examination.
2. I have been briefed concerning the Survivor Benefit Plan. I understand that I will automatically be in the plan and will pay the full
cost of coverage for my wife, and children if applicable, unless I submit an election form to the contrary prior to my retirement.
3. I am/am not (STRIKE THE INAPPROPRIATE WORDS) being considered by a HQDA Selection Board for promotion to the next higher
grade.
and end on
