DA Form 2339 Application for Voluntary Retirement Page 2
19. CONUS LOCATION OF CHOICE TRANSFER ACTIVITY
I ELECT TO BE PROCESSED FOR RETIREMENT AT:
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.
I DO NOT ELECT TO BE PROCESSED FOR RETIREMENT AT A CONUS LOCATION OF CHOICE.
SIGNATURE OF APPLICANT
I am familiar with the provisions of AR 635-200 pertaining to
withdrawal of this application for retirement once it has been
accepted by the retirement approval authority.
- (TO BE COMPLETED BY COMMANDER HAVING CUSTODY OF PERSONNEL RECORDS)
TO: (Include ZIP Code)
FROM: (Include ZIP Code)
DISAPPROVAL (Indicate reason(s) in Remarks)
21. AUTHORIZED TRANSFER ACTIVITY (If other than current installation, specify)
IS NOT SUBMITTING REQUEST IN LIEU OF ELIMINATION OR FURTHER ELIMINATION PROCEEDINGS.
(If "YES" application must be attached to board proceedings.)
HAS NOT INCURRED A SERVICE OBLIGATION (If "HAS"
24. THIS ACTION
indicate reason and expiration date in Remarks)
IN CONTRAVENTION WITH
25. SERVICE SHOWN (Items 14-18) HAS BEEN VERIFIED AS CORRECT BY:
(If other than MPRJ, attach verification)
26. DATE APPLICANT ARRIVED AT PRESENT ASSIGNMENT (Other than Oversea Command - see Item 27)
27. DATE APPLICANT OR DEPENDENT ARRIVED IN OVERSEA COMMAND (Whichever is later - specify applicant or dependent)
28. DATE OF RECEIPT OF ALERT (Nomination for assignment) OR ASSIGNMENT ORDERS (Not applicable for unit alert - see Item 31)
29. DATE MEMBERS OF UNIT WERE NOTIFIED OF UNIT ALERT
30. STATEMENT OF UNDERSTANDING
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
(Signature of member)
31. REMARKS (Continue on additional sheet if necessary)
has requested and had approved
days of transitional leave
(DDALV) to be taken in conjunction with the requested retirement action. This leave will begin
and end on
TYPED NAME, GRADE AND TITLE OF COMMANDER/PERSONNEL
APD LC v4.02ES
DA FORM 2339, JUN 1983
DA Form 7206 Application to Perform Legal Assistance Work for Retirement Points and to Be Listed in the Jagc Officer Legal Assistance Directory
DA Form 591 Application for Initial (Educational) Delay From Entry on Active Duty and Supplemental Agreement
DA Form 3499 Application for Relief From Court-Martial Findings and/Or Sentence Under the Provisions of Title 10, United States Code, Section 869
DA Form 3126 Application and Contract for Establishment of a Junior Reserve Officers' Training Corps Unit (S&i, HQDA, Attn: Tapc-Opp-P, 200 Stovall St., Alexandria, VA 22332-0418)
DA Form 1058 Application for Active Duty for Training, Active Duty for Operational Support, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve