Sample Statement of Service

by Jennifer R. Dinneen, United States Department of Defense

Sample Statement of Service

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	DEPARTMENT OF YOUR BRANCH (i.e. ARMY)	DATE

From:	Commanding Officer, [List Military Installation Here]
To:	Office of Human Resources
Subj:	STATEMENT OF SERVICE FOR [LIST NAME AND RANK HERE]

1. This is to certify that [List Name and Rank] is currently assigned to [List Military Installation Here]
   
   
2. The following information is provided:
   
   

   a. NAME OF SERVICEMEMBER: [INSERT NAME]
   
   

   b. SSN/PAYGRADE: XXX-XX-XXXX / PAYGRADE (i.e. E6)
   
   

   c. DATE OF BIRTH: XX / XX / XXXX
   
   

   d. BRANCH OF SERVICE: NAME OF BRANCH (i.e. ARMY)
   
   

   c. ACTIVE DUTY SERVICE DATE: XX MONTH XXXX
   
   

   d. EXPECTED DISCHARGE OR RELEASE DATE: XX MONTH XXXX
   
   

   e. EXPECTED CHARACTER OF DISCHARGE: HONORABLE
   
   

3. Decorations, Medals, Badges, Citations and Campaign Ribbons Awarded or Authorized (All periods of service): [Insert Medals, Badges, Citations and Campaign Ribbons Awarded or Authorized here] (Example: ARMED FORCES EXPEDITIONARY MEDAL, GLOBAR WAR ON TERRORISM MEDAL, GLOBAR WAR EXPEDITIONARY MEDAL)
   
   
4. The above information is certified to be true. If there is any questions or concern please contact Commander or Commander’s designated representative and contact info at (insert email address here) or (insert phone number here).

//Signed by commander or commander’s designated representative// Signature Block