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- Click ‘Get Form’ to open it in the editor.
- In Section I, enter your name (LAST, First, Middle Initial) and check the box if you have a new address. Fill in your current home address, including street, city, state, and zip code.
- Provide your telephone numbers: home and daytime. Then, enter your Social Security Number and select your branch of service by checking the appropriate box.
- Indicate your date of retirement in YYYYMMDD format. Specify the type of employment reported by checking NEW, ANNUAL, END OF JOB, or FINAL.
- Answer whether you have served on active duty since the beginning of this period of qualifying employment by selecting YES or NO.
- In Section II, your employer will need to fill out their information including organization name and contact details. They must also certify the dates of your full-time employment.
- Finally, in Section III, sign and date the certification to confirm that all provided information is accurate.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2003 | 4.9 Satisfied (291 Votes) |
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