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DD FORM 214 WORKSHEET PRIVACY ACT NOTIFICATION This document contains information covered under the Privacy Act of 1974 5 USC 552a and its various implementing regulations and must be protected in accordance with those provisions. You the recipient/user are obliged to maintain it in a safe secure and confidential manner. Re-disclosure without consent or as permitted by law is prohibited* Unauthorized re-disclosure or failure to maintain confidentiality subjects you to application of appropriate sanctions. If you have received this correspondence in error please notify the sender immediately and destroy any copies you have made. FOR OFFICIAL USE ONLY WHEN FILLED IN NAVCRUITDIST Officer Programs PHONE NUMBER DATE NAME LAST NAME FIRST NAME MIDDLE NAME GRADE RANK OR RATE PAYGRADE IN WHICH SEPARATED DATE OF BIRTH TYPE OF SEPARATION DISCHARGED AND REAPPOINTED IN NAVAL RESERVE TO ACCEPT COMMISSION IN SAME BRANCH OF SERVICE PER MILPERSMAN 1910-102. PERMANENT ADDRESS UPON SEPARATION STREET STATE CITY ZIP PHONE COUNTY NEXT OF KIN ADDRESS RELATIONSHIP NAME AWARDS FORMAL IN-SERVICE TRAINING COURSES SUCCESFULLY COMPLETED DURING THIS PERIOD DURATION OF ONE WEEK OR MORE COURSE TITLE NAVCRUIT 1131 /38 Rev 6-2010 NUMBER WEEKS MONTH/YEAR COMPLETED Page 1 of 1. You the recipient/user are obliged to maintain it in a safe secure and confidential manner. Re-disclosure without consent or as permitted by law is prohibited* Unauthorized re-disclosure or failure to maintain confidentiality subjects you to application of appropriate sanctions. If you have received this correspondence in error please notify the sender immediately and destroy any copies you have made. If you have received this correspondence in error please notify the sender immediately and destroy any copies you have made. FOR OFFICIAL USE ONLY WHEN FILLED IN NAVCRUITDIST Officer Programs PHONE NUMBER DATE NAME LAST NAME FIRST NAME MIDDLE NAME GRADE RANK OR RATE PAYGRADE IN WHICH SEPARATED DATE OF BIRTH TYPE OF SEPARATION DISCHARGED AND REAPPOINTED IN NAVAL RESERVE TO ACCEPT COMMISSION IN SAME BRANCH OF SERVICE PER MILPERSMAN 1910-102. FOR OFFICIAL USE ONLY WHEN FILLED IN NAVCRUITDIST Officer Programs PHONE NUMBER DATE NAME LAST NAME FIRST NAME MIDDLE NAME GRADE RANK OR RATE PAYGRADE IN WHICH SEPARATED DATE OF BIRTH TYPE OF SEPARATION DISCHARGED AND REAPPOINTED IN NAVAL RESERVE TO ACCEPT COMMISSION IN SAME BRANCH OF SERVICE PER MILPERSMAN 1910-102. PERMANENT ADDRESS UPON SEPARATION STREET STATE CITY ZIP PHONE COUNTY NEXT OF KIN ADDRESS RELATIONSHIP NAME AWARDS FORMAL IN-SERVICE TRAINING COURSES SUCCESFULLY COMPLETED DURING THIS PERIOD DURATION OF ONE WEEK OR MORE COURSE TITLE NAVCRUIT 1131 /38 Rev 6-2010 NUMBER WEEKS MONTH/YEAR COMPLETED Page 1 of 1. You the recipient/user are obliged to maintain it in a safe secure and confidential manner. Re-disclosure without consent or as permitted by law is prohibited* Unauthorized re-disclosure or failure to maintain confidentiality subjects you to application of appropriate sanctions. If you have received this correspondence in error please notify the sender immediately and destroy any copies you have made. FOR OFFICIAL USE ONLY WHEN FILLED IN NAVCRUITDIST Officer Programs PHONE NUMBER DATE NAME LAST NAME FIRST NAME MIDDLE NAME GRADE RANK OR RATE PAYGRADE IN WHICH SEPARATED DATE OF BIRTH TYPE OF SEPARATION DISCHARGED AND REAPPOINTED IN NAVAL RESERVE TO ACCEPT COMMISSION IN SAME BRANCH OF SERVICE PER MILPERSMAN 1910-102. .