CTMD Form 5-3 "Application for Appointment to the Connecticut State Guard Reserve" - Connecticut

What Is CTMD Form 5-3?

This is a legal form that was released by the Connecticut Military Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2009;
  • The latest edition provided by the Connecticut Military Department;
  • 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 a printable version of CTMD Form 5-3 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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Download CTMD Form 5-3 "Application for Appointment to the Connecticut State Guard Reserve" - Connecticut

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CTMD 5-3
(Rev 7/2009)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR
APPLICATION FOR APPOINTMENT INTO THE
CONNECTICUT STATE GUARD
PURPOSE: The Connecticut State Guard is authorized under Connecticut General Statute Section 27-9. Members of the
Connecticut State Guard (CTSG) can be ordered to active service whenever the Governor of the state deems it necessary
or in the interests of the state.
ELIGIBILITY: In order to be eligible for appointment into the CTSG, the individual must:
1. be a resident of the State of Connecticut;
2. NOT currently be a member of any component of the armed forces of the United States, to include the
Connecticut National Guard;
3. be available to be called to State Active Duty at the convenience of the Governor and/or the Adjutant General of
the State of Connecticut;
4. possess a special skill, license or degree of interest to the CTSG;
5. be medically fit to perform the duties assigned upon appointment.
6. accept an oath of office subjecting you to the orders of the Governor, The Adjutant General, the Connecticut Code
of Military Justice and pertinent service regulations.
LIMITATIONS:
Individuals approved for appointment into the CTSG will be expected to perform their duties when ordered to
State Active Duty and not necessarily at their personal convenience.
Rank and duty position will be selected based upon experience, education and commensurate positions in the
Armed Forces of the United States
Former members of the US Armed Forces may be assigned the rank they last held prior to retirement or
expiration of term of service (ETS)
individuals currently serving in the inactive ready reserve or inactive National Guard are NOT eligible for
appointment into the CTSG
individuals in the retired reserve ARE eligible for appointment into the CTSG
Officers & Warrant Officers of the CT National Guard who are promoted to the next highest rank upon
retirement in accordance with CGS 27-53 are automatically appointed to the CTSG as a condition of their
promotion.
Appointment orders will be revoked if the individual
Fails to maintain residency in Connecticut or;
o
Fails to maintain required licenses or professional certification for their duty position or;
o
Fails to keep a level of physical fitness or medical health necessary to perform duties or;
o
Reaches 65 years of age
o
DOCUMENTATION:
1. Completed and signed application form (CTMD 5-3)
2. Copy of driver’s license or CT identification card issued by the Department of Motor Vehicles
3. Copy of professional license, certificate or degree (if applicable)
4. Resume of skills, education and employment history
For more information visit http://www.ct.gov/mil or call (860) 524-4968
SEND APPLICATIONS & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
Military Administration Office
360 Broad Street Room #113
Hartford, Connecticut, 06105-3795
(860) 493-2721 (fax)
CTMD 5-3
(Rev 7/2009)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR
APPLICATION FOR APPOINTMENT INTO THE
CONNECTICUT STATE GUARD
PURPOSE: The Connecticut State Guard is authorized under Connecticut General Statute Section 27-9. Members of the
Connecticut State Guard (CTSG) can be ordered to active service whenever the Governor of the state deems it necessary
or in the interests of the state.
ELIGIBILITY: In order to be eligible for appointment into the CTSG, the individual must:
1. be a resident of the State of Connecticut;
2. NOT currently be a member of any component of the armed forces of the United States, to include the
Connecticut National Guard;
3. be available to be called to State Active Duty at the convenience of the Governor and/or the Adjutant General of
the State of Connecticut;
4. possess a special skill, license or degree of interest to the CTSG;
5. be medically fit to perform the duties assigned upon appointment.
6. accept an oath of office subjecting you to the orders of the Governor, The Adjutant General, the Connecticut Code
of Military Justice and pertinent service regulations.
LIMITATIONS:
Individuals approved for appointment into the CTSG will be expected to perform their duties when ordered to
State Active Duty and not necessarily at their personal convenience.
Rank and duty position will be selected based upon experience, education and commensurate positions in the
Armed Forces of the United States
Former members of the US Armed Forces may be assigned the rank they last held prior to retirement or
expiration of term of service (ETS)
individuals currently serving in the inactive ready reserve or inactive National Guard are NOT eligible for
appointment into the CTSG
individuals in the retired reserve ARE eligible for appointment into the CTSG
Officers & Warrant Officers of the CT National Guard who are promoted to the next highest rank upon
retirement in accordance with CGS 27-53 are automatically appointed to the CTSG as a condition of their
promotion.
Appointment orders will be revoked if the individual
Fails to maintain residency in Connecticut or;
o
Fails to maintain required licenses or professional certification for their duty position or;
o
Fails to keep a level of physical fitness or medical health necessary to perform duties or;
o
Reaches 65 years of age
o
DOCUMENTATION:
1. Completed and signed application form (CTMD 5-3)
2. Copy of driver’s license or CT identification card issued by the Department of Motor Vehicles
3. Copy of professional license, certificate or degree (if applicable)
4. Resume of skills, education and employment history
For more information visit http://www.ct.gov/mil or call (860) 524-4968
SEND APPLICATIONS & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
Military Administration Office
360 Broad Street Room #113
Hartford, Connecticut, 06105-3795
(860) 493-2721 (fax)
CTMD 5-3
(Rev 7/2009)
CONNECTICUT MILITARY DEPARTMENT
APPLICATION FOR APPOINTMENT TO THE
CONNECTICUT STATE GUARD RESERVE
APPLICANT’S PERSONAL INFORMATION
Last Name
First Name
Middle Initial
Street Address
City
State
Zip-Code
Social Security Number
Date of Birth
Marital Status
Dependent Status
Single
Divorced
Yes
Married
Widowed
No
FORMER MILITARY EXPERIENCE (if applicable)
Navy
Branch of Service
Component
Military Retiree
Marine Corps
Army
Active Duty
National Guard
Yes
Coast Guard
Air Force
Reserves
Combination
No
Highest Military
Pay Entry Base
Date of
Do you currently hold a
Have you ever been
Rank Held
Date (PEBD)
Discharge/Retirement
Security Clearance?
convicted of crime?
Yes
No
Yes
No
If Yes, when?
List Duty Positions
(include MOS, Branch, Skill Identifiers, Classification Codes, Rating, AFSC, schools attended, etc)
INFORMATION VERIFICATION, ACCESS & RELEASE AUTHORIZATION
I authorize verification/release of the information I am providing on this application. This authorization allows the
Connecticut Military Department to access my military personnel records for the purposes of evaluating this application.
Initials
STATEMENT OF CONFIDENTIALITY
This application required supporting documentation and access to your military records are the primary means of determining your eligibility to be
appointed to the Connecticut State Guard Reserve. Disclosure of the requested information, including the applicant’s social security number is
voluntary. However, failure to provide the requested information or access thereto may result in the inability to verify eligibility based on the lack of
sufficient information. Unverified eligibility will result in the denial and return of this application.
I attest that the information provided on this application is true and correct to the best of my knowledge and understand that appointment to the CTSG
authorizes me to participate in State Active Duty functions and that I will be subject to the Connecticut Code of Military Justice and pertinent service
regulations.
SIGNATURE
DATE
TO BE COMPLETED BY CONNECTICUT MILITARY DEPARTMENT
APPROVED
Effective Date
Expiration Term of Service
Approved Rank
SIGNATURE OF MILITARY ADMINISTRATIVE OFFICER
DATE
Permanent Order
REJECTED
Reason:
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