This document is a National Guard Report of Separation and Record of Service. It provides identifying information about a service member, including name, social security number, dates of service, rank, military education, awards, security clearance level, and character of separation. The form is used to document a service member's record when separating from the National Guard.
This document is a National Guard Report of Separation and Record of Service. It provides identifying information about a service member, including name, social security number, dates of service, rank, military education, awards, security clearance level, and character of separation. The form is used to document a service member's record when separating from the National Guard.
This document is a National Guard Report of Separation and Record of Service. It provides identifying information about a service member, including name, social security number, dates of service, rank, military education, awards, security clearance level, and character of separation. The form is used to document a service member's record when separating from the National Guard.
This document is a National Guard Report of Separation and Record of Service. It provides identifying information about a service member, including name, social security number, dates of service, rank, military education, awards, security clearance level, and character of separation. The form is used to document a service member's record when separating from the National Guard.
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NATIONAL GUARD REPORT OF SEPARATION AND RECORD OF SERVICE
The proponent agency is ARNG-HRH. The prescribing directive is NGR 600-200.
Report of separation and record of service in the 1. LAST NAME- FIRST NAME- MIDDLE NAME National Guard of 2. DEPARTMENT, COMPONENT AND BRANCH and as a Reserve of the 3. SOCIAL SECURITY NUMBER
4. DATE OF ENLISTMENT
5a. RANK
5B. PAY GRADE
6. DATE OF RANK
7. DATE OF BIRTH
8a. STATION OR INSTALLATION AT WHICH EFFECTED
8b. EFFECTIVE DATE
9. COMMAND TO WHICH TRANSFERRED
10. RECORD OF SERVICE (a) NET SERVICE THIS PERIOD (b) PRIOR RESERVE COMPONENT SERVICE (c) PRIOR ACTIVE FEDERAL SERVICE
YEARS
MONTHS
DAYS
11. TERMINAL DATE OF RESERVE/MILITARY SERVICE OBLIGATION
(d) TOTAL SERVICE FOR PAY (e) TOTAL SERVICE FOR RETIRED PAY
12. MILITARY EDUCATION (Course Title, number of weeks, month and year completed)
13. PRIMARY SPECIALTY NUMBER , TITLE AND DATE AWARDED
(Additional specialty numbers and titles)
14. HIGHEST EDUCATION LEVEL SUCCESSFULLY COMPLETED SECONDARY/HIGH SCHOOL COLLEGE YRS (Gr 1-12) YRS
15. DECORATIONS, MEDALS, BADGES, COMMENDATIONS, CITATIONS AND CAMPAIGN RIBBONS AWARDED THIS PERIOD (State Awards may be included)
16. SERVICEMAN'S GROUP LIFE INSURANCE COVERAGE YES NO AMT
17. PERSONNEL SECURITY INVESTIGATION
a. TYPE b. INVESTIGATION
18. REMARKS
19. MAILING ADDRESS AFTER SPERATION (Street, City, County, State, and Zip Code)
20. SIGNATURE OF PERSON BEING SEPERATED
21. NAME, GRADE AND TITLE OF AUTHORIZING OFFICER
22. SIGNATURE OF OFFICER AUTHORIZED TO SIGN
23. AUTHORITY AND REASON
24. CHARACTER OF SERVICE
25. TYPE OF CERTIFICATE USED
26. REENLISTMENT ELIGIBILTY
27.
REQUEST
DECLINE COPIES OF MY NGB FORM 22 (USE PREVIOUS EDITIONS UNTIL EXHAUSTED)
