Da Form 2339 is a Department of the Army form used to request space and telecommunications services from a commercial provider. The form can be used by anyone in the army, including active duty personnel, reservists, Department of the Army civilians, and family members. The form must be completed in full and signed by the requester before submitting to the commercial provider. Some common reasons for completing the form include requesting phone or internet service, satellite TV service, or connecting to defense networks. Completing the form correctly is important in order to ensure that you receive the services you need in a timely manner. If you have any questions about how to complete the Da Form 2339, contact your local installation support center.
| Question | Answer |
|---|---|
| Form Name | Da Form 2339 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | application voluntary retirement, da for retirement, form voluntary retirement, sample da form 2339 |
APPLICATION FOR VOLUNTARY RETIREMENT
For use of this form, see AR
DATE
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DATA REQUIRED BY THE PRIVACY ACT |
AUTHORITY: |
Title 10, United States Code, Chapters 61, 63 and 67. |
PRINCIPAL PURPOSE: |
To initiate necessary administrative action in regard to voluntary requests for retirement. |
ROUTINE USES: |
Data contained on the form is used to complete administrative actions incident to retirement. |
DISCLOSURE: |
Disclosure is voluntary. However, failure to disclose required information may result in service member not |
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being considered for voluntary retirement. |
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TO: (Include ZIP Code)
THRU: (Include ZIP Code)
SECTION I - (TO BE COMPLETED BY ALL APPLICANTS)
1. NAME (Last, First, Middle) |
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2. SSN |
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3. ETS |
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4. DESIRED RETIREMENT |
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DATE |
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5. CURRENT GRADE, PAY GRADE, (Effective date of promotion) |
6. HIGHEST GRADE SERVED ON ACTIVE DUTY AND BRANCH OF |
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AND MOS |
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SERVICE |
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7. UNIT OF ASSIGNMENT - DUTY STATION - MAJOR COMMAND |
8. DESIRE RETIREMENT AT CURRENT OVERSEA ASSIGNMENT |
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(CONUS Residents only) |
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YES |
NO |
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NOT APPLICABLE |
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9. MAIL ADDRESS UPON RETIREMENT (Will not be considered as |
10. |
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home of selection) (Include ZIP Code) |
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RETIREMENT |
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HOR |
CONUS |
CURRENT OVERSEAS STATION |
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11. REQUEST TRANSFER TO RETIRED RESERVE IN THE FOLLOWING STATUS |
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COMMISSIONED |
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WARRANT OFFICER |
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ENLISTED |
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12. |
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(TO BE COMPLETED ONLY BY RESERVE OFFICERS SERVING ON ACTIVE DUTY IN ENLISTED STATUS) |
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a. RESERVE COMMISSIONED STATUS |
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b. GRADE & PROMOTION |
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c. BRANCH |
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RETIRED |
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ACTIVE |
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ELIGIBILITY DATE |
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13. AWARDS |
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MEDAL OF HONOR |
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DISTINGUISHED SERVICE CROSS |
NAVY CROSS |
NONE |
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SOLDIERS MEDAL |
DISTINGUISHED FLYING CROSS OR EQUIVALENT NAVY DECORATION |
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14. |
CHRONOLOGICAL DATES OF MILITARY SERVICE |
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TIME |
ACTIVE FEDERAL |
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INACTIVE SERVICE |
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(Enlistment and Discharge dates and change in status from active to |
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LOST |
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SERVICE |
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inactive service and vice versa.) (Para |
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ENL. WO. |
COM- |
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FROM |
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TO |
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TOTAL |
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TOTAL |
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COM |
PONENT |
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YEAR |
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MO |
DAY |
YEAR |
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MO |
DAY |
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DAYS |
YEARS |
MONTHS |
DAYS |
YEARS MONTHS DAYS |
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(Indicate) |
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15.TOTAL TIME LOST (If no time lost, enter "None")
16.TOTAL ACTIVE SERVICE CREDITABLE FOR RETIREMENT (Do not include time lost)
17.TOTAL INACTIVE SERVICE CREDITABLE FOR BASIC PAY ONLY
18. TOTAL SERVICE FOR BASIC PAY PURPOSES (Item 16 + 17)
DA FORM 2339, JUN 83 |
EDITION OF APR 78 WILL BE USED UNTIL EXHAUSTED. |
USAPA V4.00
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
I DO NOT ELECT TO BE PROCESSED FOR RETIREMENT AT A CONUS LOCATION OF CHOICE.
I am familiar with the provisions of AR
SIGNATURE OF APPLICANT
SECTION II - (TO BE COMPLETED BY COMMANDER HAVING CUSTODY OF PERSONNEL RECORDS)
TO: (Include ZIP Code)
FROM: (Include ZIP Code)
DATE
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" |
indicate reason and expiration date in Remarks)
24. THIS ACTION IS IS NOT
IN CONTRAVENTION WITH AR
25.SERVICE SHOWN (Items
OTHER (Specify)
MPRJ AGPERSCEN:
(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 |
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1. I have read Section V, Chapter 12, AR
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 |
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TYPED NAME, GRADE AND TITLE OF COMMANDER/PERSONNEL |
SIGNATURE |
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OFFICER |
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DA FORM 2339, JUN 83 |
USAPA V4.00 |