RESERVE JAG/LN DATABASE INPUT FORM
(Italicized items are never published or placed on the web. They will be maintained in the database)
| NAME (the name by which you wish to be known) | NICKNAME | RANK | Branch of Service | ||
| FULL NAME (full first, middle & last names) | Spouse=s Name | Publish Spouse=s Name (Y/N)? | Date of Rank (Officer & Enlisted) | Lineal Number | |
| Date of Birth | Date of Entrance on Duty (Enlisted) | Gender | PEBD | Date Commissioned | |
| Date Retired | |||||
**** PUBLISH FOLLOWING EMPLOYMENT INFORMATION? YES____NO____ ****
| Primary Type of Employment | Employer/Agency | Your Job Title |
| Address, City & State & Zip Code of Employer | Area Code + Phone Number | FAX Number | |
| Pager Number | Office E-Mail Address | ||
| Secondary Type of Employment | Employer/Agency | Your Job Title |
| Address, City & State & Zip Code of Employer | Area Code + Phone Number | FAX Number | |
| Pager Number | Office E-Mail Address | ||
***** PUBLISH MAILING ADDRESS INFORMATION? YES____ NO____ *****
| Preferred Mailing Address (Indicate if you prefer your office or home address or add another one. If you add another one, please add the street address, city, state and zip code. |
***** PUBLISH RESIDENCE INFORMATION? YES____ NO____ *****
| RESIDENCE ADDRESS (street address, city, state and zip code) | ||
| Area Code & Phone Number | Area Code & FAX Number | E-Mail address |
| REDCOM | UNIT RUIC | UNIT NAME | CURRENT UNIT POSITION | DATE JOINED UNIT |
| PRACTICE AREAS | NOBCs/NECs | COCIs (List Civilian Occupation Code or provide description and code will be assigned.) |
| CIVILIAN ACCOMPLISHMENTS (e.g., Honorary Doctorate; Order of the Coif; Presidential Fellow) | CIVILIAN LICENSES (e.g., CPA, MD, RN) | CIVILIAN CERTIFICATIONS |
|
| MILITARY ACCOMPLISHMENTS (e.g., prior unit positions - CO-LSO, XO-VTU, RC) | MILITARY CERTIFICTIONS (e.g., Career Counselor, Surface Warfare, Naval Aviator) | MILITARY COURSES ATTENDED |
|
| MILITARY DECORATIONS (e.g., Silver Star, N&MC Medal, Purple Heat, Navy Achievement Medal; include number of each) | NAVAL RESERVE AWARDS (including Law Program Awards, Commendations, Letters of Appreciation and Sailor of the Quarter/Year; include number of each) |
|
| DEGREES EARNED | YEAR | SCHOOL |
| FEDERAL COURTS ADMITTED | YEAR | FOREIGN LANGUAGE SKILL | LEVEL PROFICIENCY? | |
****************************** IMPORTANT *********************************
I choose to publish the above information as indicated. Confirm by entering X _______
I choose not to publish any information other than my name. Confirm by entering X _______
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| COMMENTS
ARE APPRECIATED AND WILL BE READ!! PLACE COMMENTS HERE:
|
Thanks for completing this Database Input Form!!
PLEASE EMAIL IT TO: RJAGWebmaster@jag.navy.mil Please note that this is not the general e-mail account for our Web page, but is dedicated for database purposes only).
Or, you can fax it to: Code 62 (202) 685-7159, DSN 325-7159.
Or mail it to: Office of the Judge Advocate General (Code 62), Department of the Navy, Washington Navy Yard, 1322 Patterson Avenue SE, Suite 3000, Washington, DC 20374-5066.