DD Form 2715-3 "Prisoner Restoration/Return to Duty, Clemency and Parole Statement"

What Is DD Form 2715-3?

DD Form 2715-3 also known as the Prisoner Restoration, Return to Duty, Clemency and Parole Statement is a document used by the U.S. Army correctional system to make a request for return to duty, consideration for preliminary parole or clemency.

The DD 2715-3 was last revised by the Department of Defense (DoD) in March 2013 - an up-to-date fillable version is available for download below. Filing the form is obligatory for all inmates regardless of whether they desire parole or not.

The DD Form 2715-3 is used for gathering information related to the prisoner and may become part of their clemency and parole-related paperwork package along with forms DD 2715, DD 2715-1 and DD 2715-2. More information about parole and links to all applicable forms can be found below.

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DD form 2715-3 Instructions

The DD 2751-3 can be filed in several ways according to its purpose:

  1. Only Sections I, II and IV are completed in cases when the prisoner does not desire parole. The form will still be forwarded if a prisoner is unable to or refuses to file and sign.
  2. Prisoners who refused parole and those whose requests were denied by the Department of the Army Headquarters may request parole again prior to the next annual eligibility date.
  3. If the prisoner desires parole, all sections of the form should be filled completely. The prisoner must then submit the form to the commander or representative no later than 4 days and no earlier than 45 days prior to parole consideration.

The prisoner will then be assisted with developing a parole plan and will agree to abide by that plan in writing.

DD 2715-3 Related Forms

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Download DD Form 2715-3 "Prisoner Restoration/Return to Duty, Clemency and Parole Statement"

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REPORT DATE
(YYYYMMDD)
PRISONER RESTORATION/RETURN TO DUTY, CLEMENCY AND PAROLE STATEMENT
(Read Privacy Act Statement before completing form.)
2. DoD ID/SSN
1. NAME
(Last 4 only)
(Last, First, Middle)
3. CORRECTIONAL FACILITY
SECTION I - RESTORATION/RETURN TO DUTY
I REQUEST SUSPENSION OF THE DISCHARGE/DISMISSAL ADJUDGED BY COURT-MARTIAL IN MY CASE, AND RESTORATION.
4.
I understand that any unsatisfactory conduct on my part may violate the probation and vacation of suspension could result in execution of the
remainder of the court-martial sentence in addition to further disciplinary action.
5.
I DO NOT REQUEST TO BE RESTORED/RETURNED TO DUTY.
SECTION II - CLEMENCY
6.
I HEREBY WAIVE MY RIGHT TO BE CONSIDERED FOR CLEMENCY.
a. I understand my case will not be reviewed administratively for remission, mitigation, or suspension of the unexecuted parts of my
sentence. I further understand that I will not receive consideration for annual clemency until one year after my current clemency board
date.
b. I also acknowledge that if my sentence includes an unsuspended punitive discharge or dismissal:
(1) I may be ineligible for many or all benefits as a veteran under both Federal and state laws.
(2) I may expect to encounter substantial prejudice in civilian life.
(3) This waiver will remain part of my permanent military service record.
(4) I may not reenlist without special permission (enlisted members only).
7. I HEREBY REQUEST TO BE CONSIDERED FOR CLEMENCY IN THE FOLLOWING FORM(S):
Reduction in length of sentence.
Reduction or remission of forfeitures.
Reduction or remission of fine.
Substitution of administrative discharge for punitive discharge.
(Note: Does not apply to Air Force prisoners.)
Remission of dismissal
.
(officers and cadets only)
Mitigation of a DD to a BCD.
Restoration to pay grade
.
Restoration of precedence
.
(officers only)
8. MY REASON(S) FOR REQUESTING CLEMENCY ARE AS FOLLOWS:
9. PRISONER/SUPERVISEE SIGNATURE
10. WITNESS SIGNATURE
11. DATE
(YYYYMMDD)
CERTIFICATION TO BE COMPLETED FOR CLEMENCY WAIVER ONLY
12. CERTIFIED: I certify that the above individual signed this waiver in my presence, and that his/her right to request clemency and the effect of this
waiver have been fully explained to him/her.
a. CERTIFYING OFFICIAL
c. DATE
b. SIGNATURE OF CERTIFYING OFFICIAL
(Name, Grade and Title)
(YYYYMMDD)
DD FORM 2715-3, MAR 2013
Page 1 of 2 Pages
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
REPORT DATE
(YYYYMMDD)
PRISONER RESTORATION/RETURN TO DUTY, CLEMENCY AND PAROLE STATEMENT
(Read Privacy Act Statement before completing form.)
2. DoD ID/SSN
1. NAME
(Last 4 only)
(Last, First, Middle)
3. CORRECTIONAL FACILITY
SECTION I - RESTORATION/RETURN TO DUTY
I REQUEST SUSPENSION OF THE DISCHARGE/DISMISSAL ADJUDGED BY COURT-MARTIAL IN MY CASE, AND RESTORATION.
4.
I understand that any unsatisfactory conduct on my part may violate the probation and vacation of suspension could result in execution of the
remainder of the court-martial sentence in addition to further disciplinary action.
5.
I DO NOT REQUEST TO BE RESTORED/RETURNED TO DUTY.
SECTION II - CLEMENCY
6.
I HEREBY WAIVE MY RIGHT TO BE CONSIDERED FOR CLEMENCY.
a. I understand my case will not be reviewed administratively for remission, mitigation, or suspension of the unexecuted parts of my
sentence. I further understand that I will not receive consideration for annual clemency until one year after my current clemency board
date.
b. I also acknowledge that if my sentence includes an unsuspended punitive discharge or dismissal:
(1) I may be ineligible for many or all benefits as a veteran under both Federal and state laws.
(2) I may expect to encounter substantial prejudice in civilian life.
(3) This waiver will remain part of my permanent military service record.
(4) I may not reenlist without special permission (enlisted members only).
7. I HEREBY REQUEST TO BE CONSIDERED FOR CLEMENCY IN THE FOLLOWING FORM(S):
Reduction in length of sentence.
Reduction or remission of forfeitures.
Reduction or remission of fine.
Substitution of administrative discharge for punitive discharge.
(Note: Does not apply to Air Force prisoners.)
Remission of dismissal
.
(officers and cadets only)
Mitigation of a DD to a BCD.
Restoration to pay grade
.
Restoration of precedence
.
(officers only)
8. MY REASON(S) FOR REQUESTING CLEMENCY ARE AS FOLLOWS:
9. PRISONER/SUPERVISEE SIGNATURE
10. WITNESS SIGNATURE
11. DATE
(YYYYMMDD)
CERTIFICATION TO BE COMPLETED FOR CLEMENCY WAIVER ONLY
12. CERTIFIED: I certify that the above individual signed this waiver in my presence, and that his/her right to request clemency and the effect of this
waiver have been fully explained to him/her.
a. CERTIFYING OFFICIAL
c. DATE
b. SIGNATURE OF CERTIFYING OFFICIAL
(Name, Grade and Title)
(YYYYMMDD)
DD FORM 2715-3, MAR 2013
Page 1 of 2 Pages
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
SECTION III - PAROLE
13. UNDER REGULATION I BECOME ELIGIBLE FOR PAROLE CONSIDERATION ON (YYYYMMDD):
14.
I DESIRE
DO NOT DESIRE TO BE CONSIDERED FOR PAROLE FOR THE FOLLOWING REASONS:
15. PROPOSED PAROLE RESIDENCE
:
(State fully where and with whom you will live)
a. NAME
b. RELATIONSHIP
c. TELEPHONE NUMBER
(Last, First, Middle Initial)
(Include area code)
d. STREET ADDRESS
e. CITY
f. STATE
g. ZIP CODE
(Include apartment number)
16. PROPOSED
EMPLOYER
SCHOOL
a. EMPLOYER OR SCHOOL NAME
b. TELEPHONE NUMBER
(Include area code)
c. STREET ADDRESS
d. CITY
e. STATE
f. ZIP CODE
(Include apartment number)
g. TITLE OR POSITION
h. RATE OF PAY
(1) FULL TIME
(2) PART TIME
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 874(a), 952-954; DoD Instruction 1325.07; and E.O. 9397.
PRINCIPAL PURPOSE(S): To allow official military personnel to review requests for restoration/return to duty, clemency, or parole and provide
recommendations to the appropriate Military Service Clemency and Parole Board.
ROUTINE USE(S): The DoD "blanket routine uses" found at http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html apply to the
completed form.
DISCLOSURE: Voluntary; however, failure to provide the requested information may prevent the Board from considering your eligibility for clemency
or parole.
17. PRISONER/SUPERVISEE SIGNATURE
18. DATE
(YYYYMMDD)
19. WITNESS NAME
, GRADE, TITLE
20. SIGNATURE
21. DATE
(Last, First, Middle Initial)
(YYYYMMDD)
DD FORM 2715-3, MAR 2013
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