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F245-030-000 Statement for Retraining and Job Modification Services 12-2017. Mail completed form to: PO Box 44269.Easy to use and ready to print;; Quick to customize;; Compatible with most PDF-viewing applications;; Fill out the form in our online filing application. Download Statement for Retraining and Job Modification Services (F245-030-999) – Department of Labor and Industries (Washington) form. Feel free to make any other changes to meet your needs before uploading the document to Gardiant. Statement for Retraining and Job Modification Services.docx. RECENT PERIODS OF SERVICE (PERIODS OF ACTIVE DUTY SINCE YOUR INITIAL PERIOD OF ACTIVE DUTY.) Please complete this section for each period of your. You can complete some forms online, while you can download and print all others. U.S. Department of Health and Human Services. Public Health Service.