DA Form 2339 Application for Voluntary Retirement Page 2

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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)
SECTION II
DATE
TO: (Include ZIP Code)
FROM: (Include ZIP Code)
20. RECOMMEND
APPROVAL
DISAPPROVAL (Indicate reason(s) in Remarks)
21. AUTHORIZED TRANSFER ACTIVITY (If other than current installation, specify)
22. APPLICANT
IS
IS NOT SUBMITTING REQUEST IN LIEU OF ELIMINATION OR FURTHER ELIMINATION PROCEEDINGS.
(If "YES" application must be attached to board proceedings.)
23. APPLICANT
HAS
HAS NOT INCURRED A SERVICE OBLIGATION (If "HAS"
24. THIS ACTION
IS
IS NOT
indicate reason and expiration date in Remarks)
IN CONTRAVENTION WITH
AR 600-31
25. SERVICE SHOWN (Items 14-18) HAS BEEN VERIFIED AS CORRECT BY:
MPRJ
AGPERSCEN:
OTHER (Specify)
(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)
DATE:
NOT APPLICABLE
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
DATE:
NOT APPLICABLE
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
grade.
(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
on
and end on
TYPED NAME, GRADE AND TITLE OF COMMANDER/PERSONNEL
SIGNATURE
OFFICER
APD LC v4.02ES
DA FORM 2339, JUN 1983

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