Encl (1) to COMDTINST 1780.1
DEPARTMENT OF
TRANSPORTAION
U.S. COAST GUARD
CG-5687 (11/01)
- Continued -
MISCELLANEOUS INFORMATION
Community / Volunteer Activities
Work Experience
Dates of Employment / Company Name & Address / Type of Work
Additional Information
I assert that the above information is true
and correct to the best of my knowledge:
(Signature)
(Date)
(Print Name)
2