APPLICATION FOR IDENTIFICATION CARD/DEERS …

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SECTION V - RECEIPTSECTION IV - DEPENDENT INFORMATION (Attach additional pages if necessary)SECTION III - AUTHORIZED BYSECTION II - SPONSOR/EMPLOYEE DECLARATION AND REMARKSSECTION I - SPONSOR/EMPLOYEE INFORMATIONAPPLICATION FOR IDENTIFICATION CARD/DEERS ENROLLMENTPlease read Agency Disclosure Notice, Privacy Act Statement, and Instructions prior to completing this No. 0704-0415OMB approval expiresJan 31, 2014 1. NAME (Last, First, Middle)2. GENDER 3. SSN OR DOD ID NO. 4. STATUS5. ORGANIZATION 6. PAY GRADE11. CURRENT HOME ADDRESS12. CITY13. STATE14.

instructions privacy act statement agency disclosure notice please do not return your completed form to the above organization. return completed form to a real-time automated personnel identification …

  Applications, Identification, Deer, Card, Application for identification card deers