Da 7434 Fillable Form

COMMANDER S AUTHENTICATION 24. COMMANDER S SIGNATURE DA FORM 7434 JUL 2009 APPROVED APD LC v1.00ES. APPLICATION FOR US ARMY MARINE CERTIFICATION For use of this form see AR 56-9 the proponent agency is DCS G-4. READ BEFORE SIGNING Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies conceals or covers up by trick scheme or device a material fact or makes or uses any false writing on a document knowing the same to contain any false fictitious or fraudulent statement or entry shall be fined not more than 10 000 or imprisonment of not more than 5 years or both. 18 USC 1001 1. TYPE OF CERTIFICATION Check one ORIGINAL RENEWAL UPGRADE ENDORSEMENT 2. NAME Last First MI 3. GRADE 4. DOR 5. PRIMARY MOS 6. UNIT OF ASSIGNMENT 8. DATE YYYYMMDD 7. APPLICANTS SIGNATURE PHYSICAL STATEMENT In accordance with AR 56-9 Watercraft Physical Standards 1. Profile serial MUST be 2 or better for P U L H E and be 1 for S* 2. MUST pass color perception using the Pseudoisochromatic Plate PIP test and have visual acuity required by Chapter 5-2. 9. PROFILE 10. DATE OF LAST PHYSICAL YYYYMMDD P U L H E S 11. MEDICAL CORPS/MEDICAL SERVICE CORPS SIGNATURE Required 12. GRADE 13. MOS/BRANCH 14. TITLE 15. VERIFICATION DATE YYYYMMDD 16. COLOR PERCEPTION 16a* TEST TYPE 16b. SCORE / PASS FAIL 17. VISUAL ACUITY 17b. CORRECTED 17a* UNCORRECTED R 18. OPTOMETRIST SIGNATURE Required APPLICATION IS VALID FOR ONE YEAR FROM ABOVE DATE 23. APPLICATION FOR US ARMY MARINE CERTIFICATION For use of this form see AR 56-9 the proponent agency is DCS G-4. READ BEFORE SIGNING Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies conceals or covers up by trick scheme or device a material fact or makes or uses any false writing on a document knowing the same to contain any false fictitious or fraudulent statement or entry shall be fined not more than 10 000 or imprisonment of not more than 5 years or both. READ BEFORE SIGNING Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies conceals or covers up by trick scheme or device a material fact or makes or uses any false writing on a document knowing the same to contain any false fictitious or fraudulent statement or entry shall be fined not more than 10 000 or imprisonment of not more than 5 years or both. 18 USC 1001 1. TYPE OF CERTIFICATION Check one ORIGINAL RENEWAL UPGRADE ENDORSEMENT 2. NAME Last First MI 3. 18 USC 1001 1. TYPE OF CERTIFICATION Check one ORIGINAL RENEWAL UPGRADE ENDORSEMENT 2. NAME Last First MI 3. GRADE 4. DOR 5. PRIMARY MOS 6. UNIT OF ASSIGNMENT 8. DATE YYYYMMDD 7. APPLICANTS SIGNATURE PHYSICAL STATEMENT In accordance with AR 56-9 Watercraft Physical Standards 1. GRADE 4. DOR 5. PRIMARY MOS 6. UNIT OF ASSIGNMENT 8. DATE YYYYMMDD 7. APPLICANTS SIGNATURE PHYSICAL STATEMENT In accordance with AR 56-9 Watercraft Physical Standards 1. Profile serial MUST be 2 or better for P U L H E and be 1 for S* 2. MUST pass color perception using the Pseudoisochromatic Plate PIP test and have visual acuity required by Chapter 5-2.