Enclosure (3) to COMDINST 1750.4D
PAGE 3 OF CG-6078 (3-06)
13. I HEREBY CERTIFY THAT ALL ENTRIES ON THIS APPLICATION ARE TRUE AND COMPLETE. I
UNDERSTAND THAT ANY FALSIFIED INFORMATION OR MISREPRESENTATION OF THE FACTS MAY RESULT
IN THE DENIAL OF SELECTION OR REVOCATION OF APPOINTMENT REGARDLESS OF LENGTH OF SERVICE. I
AUTHORIZE THE COMMANDING OFFICER, OR THEIR DESIGNEE(S), TO INVESTIGATE THE INFORMATION
GIVEN IN THIS APPLICATION WITH THE PROPER AGENCIES/PERSONS. FURTHERMORE, I AGREE TO ABIDE
BY THE APPLICABLE REGULATIONS AND POLICIES OF THE COAST GUARD COMMAND FAMILY
OMBUDSMAN PROGRAM AS PRESCRIBED BY COMMANDANT INSTRUCTION 1750 UNDER THE SUPERVISION
AND GUIDANCE OF THE COMMANDING OFFICER OF THIS COMMAND OR THEIR DULY APPOINTED
REPRESENTATIVE.
NOTICE TO VOLUNTEER
14. I UNDERSTAND VOLUNTEERS ARE NOT CONSIDERED TO BE FEDERAL EMPLOYEES FOR ANY PURPOSES
OTHER THAN TORT CLAIMS AND INJURY COMPENSATION. VOLUNTEER SERVICE IS NOT CREDITABLE FOR LEAVE
ACCRUAL OR ANY OTHER BENEFIT. HOWEVER, VOLUNTEER SERVICE IS CREDITABLE FOR WORK EXPERIENCE.
OMBUDSMAN INITIALS
PRINT NAME:
DATE:
SIGNATURE:
Previous Page
