Enclosure (2) to COMDTINST 12500.2
Part 4. Service Agreement for Receipt of Payment for a Recruitment/Relocation Bonus.
Note:
a. Leave blank the beginning and ending dates until the request has been approved and these dates can be
established.
b. The agreement must be signed prior to submitting this form for approval. Signature by the prospective
bonus recipient is not binding upon the employee until the personnel action (e.g., appointment or
relocation) is effected; nor does the prospective employee's signature commit the Coast Guard to
approve the request.
I hereby agree to remain as an employee of the United States Coast Guard for the period beginning
________________ and ending on ___________________ [the period specified will cover 12 months]
following the effective date of my appointment/relocation, unless I am involuntarily separated for reasons
beyond my control and which are acceptable to the Coast Guard. The amount of the bonus I will be
receiving under this agreement is _____________________. I agree that if I do not remain in the employ of
the Coast Guard (if this service agreement is for a relocation bonus, I agree that the service will be
performed at the agreed duty location) for the above specified period I will repay to the Coast Guard the
bonus on a pro rata basis. The amount to be repaid shall be determined by providing credit for each full
month of employment completed under this agreement. I understand that under such circumstances these
monies are recoverable from me as a debt due to the United States Government.
____________________________________________________________________
Name and Signature of Recipient
Date
DEPT. OF TRANSP., USCG, CG-5659 (5-99) 4
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