DATE SIGNED YYYYMMDD 8. SIGNATURE OF RECRUITING REPRESENTATIVE 9. UNIT/COMMAND MAILING ADDRESS Street City State and ZIP Code DD FORM 370 MAR 2009 PREVIOUS EDITION IS OBSOLETE. Adobe Professional 8. SPECIFICALLY ADDRESS THE ABOVE ITEMS. IF ITEM17 IS MARKED YES PLEASE EXPLAIN IN DETAIL. 19. PERSON COMPLETING QUESTIONNAIRE a. TYPED OR PRINTED NAME Last First Middle Initial c. SIGNATURE DD FORM 370 BACK MAR 2009 b. OMB No. 0704-0167 OMB approval expires Oct 31 2011 REQUEST FOR REFERENCE PLEASE RETURN YOUR FORM TO THE ADDRESS SHOWN IN THE TO BLOCK BELOW. The public reporting burden for this collection of information is estimated to average 10 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing the burden to the Department of Defense Washington Headquarters Services Executive Services Directorate Information Management Division 1155 Defense Pentagon Washington DC 20301-1155 0704-0167. Respondents should be aware that notwithstanding any other provision of law no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. THIS FORM CONTAINS INFORMATION SUBJECT TO THE PRIVACY ACT OF 1974 AS AMENDED. TO Your timely reply will help the defense effort. Please fill out and return promptly. A return envelope which requires no postage is enclosed for your convenience. APPLICANT IDENTIFICATION DATA 2. MAILING ADDRESS Street Apartment Number City State and ZIP Code 1. NAME Last First Middle Initial 3. DATE OF BIRTH YYYYMMDD 4. DATES OF SCHOOL ATTENDANCE OR EMPLOYMENT a* FROM YYYYMMDD b. TO YYYYMMDD The above-named person has made application for enlistment in the Armed Service and has given your name as a reference. The information you provide will be appreciated since it will assist in determining whether or not the applicant meets the eligibility standards to become a member of the Armed Forces of the United States. Service standards require that applicants be mature intelligent and possess high moral qualifications. Those applicants who are selected will have an opportunity to receive schooling and training in technical fields to improve and advance their knowledge and skills in subjects essential to national defense. Additionally college opportunities will be available. Enlistees who cannot adjust satisfactorily to military life must be discharged causing emotional distress to the individual as well as loss to the taxpayers. Therefore by giving your frank opinion of the applicant you can render a genuine service to the applicant as well as to the United States. Your statements will be held in strict confidence and you will not be considered personally responsible in any way for the applicant s conduct if enlisted or not enlisted* Your answers to the questions listed on the back of this form are of particular interest in reaching a conclusion concerning the qualifications of the applicant.
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