Military Fraudulent Enlistment Waiver Form
Use this form to request review of a fraudulent enlistment issue and provide the information needed for waiver consideration.
Applicant Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Branch of Service / Military Affiliation
*
Army
Navy
Air Force
Marine Corps
Coast Guard
Space Force
Other
Enlistment Details
Enlistment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Enlistment Location or Recruiting Office
*
Current Status of Enlistment/Contract
*
Active
Pending
Separated
Under Review
Other
Fraudulent Enlistment Disclosure
Concise description of the alleged or confirmed fraudulent enlistment issue
*
When the issue was discovered
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is the applicant requesting waiver review?
*
Yes
No
Waiver Acknowledgment and Submission
Applicant Signature
*
Signature Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Form
Submit Form
Should be Empty: