SAMPLE APPLICATION FORMAT FOR SENIOR SURFACE CSRB

							   SAMPLE APPLICATION FORMAT FOR SENIOR SURFACE
                       CSRB
________________________________________________________________

                                                            DATE

FROM: ELIGIBLE OFFICER’S NAME, SSN/DESIG
TO:   COMMANDER NAVY PERSONNEL COMMAND (PERS-41)

SUBJ: REQUEST FOR SENIOR SURFACE WARFARE OFFICER CRITICAL SKILLS
      RETENTION BONUS

REF:   (A) NAVADMIN 259/04
       (B) NAVADMIN 084/10
       (C) 37 USC 323

1. I HAVE READ AND UNDERSTAND THE PROVISIONS OF REFERENCE (A)
INCLUDING ALL PROVISIONS RELATING TO TERMINATION OF PAYMENTS TO
BE MADE UNDER THIS AGREEMENT AND THE CIRCUMSTANCES UNDER WHICH
RECOUPMENT BY THE GOVERNMENT OF SUMS PAID MAY BE REQUIRED, TO
WHICH I AGREE. I HEREBY APPLY FOR SENIOR SURFACE CSRB SPECIAL
PAY AUTHORIZED IN REFERENCE (A) AND UNDER THE GUIDELINES OF
REFERENCE (B).

2. (REGULAR OFFICER w/ less than 24 Years of Service) CONTINGENT
UPON ACCEPTANCE OF MY APPLICATION FOR THIS SPECIAL PAY, I AGREE
NOT TO TENDER A RESIGNATION WHICH WILL BE EFFECTIVE PRIOR TO
COMPLETION OF THE PERIOD OF OBLIGATION. I UNDERSTAND THAT, UPON
ACCEPTANCE, THIS APPLICATION IS BINDING, AND THEREUPON I SHALL
BE ELIGIBLE TO RECEIVE THE SPECIAL PAY DISCUSSED IN REFERENCE
(A) IN ACCORDANCE WITH THE DISBURSEMENT SCHEDULE DELINEATED IN
REFERENCE (A). I FURTHER UNDERSTAND THAT IF, FOR ANY REASON, I
DON’T SERVE IN THE BILLET BEYOND ONE YEAR FROM THE DATE MY
APPROVED ELIGIBILITY BEGINS, I WILL BE RESPONSIBLE FOR A PRO
RATA RECOUPMENT OF UNEARNED BONUS MONEY.

2. (REGULAR OFFICER w/ more than 24 Years of Service)
CONTINGENT UPON ACCEPTANCE OF MY APPLICATION FOR THIS SPECIAL
PAY, I AGREE NOT TO TENDER A RESIGNATION WHICH WILL BE EFFECTIVE
PRIOR TO ONE YEAR AFTER THE DATE OF APPROVAL OF MY APPLICATION
OR ONE YEAR AFTER THE DATE OF MY ARRIVAL IN THE QUALIFYING
BILLET, WHICHEVER IS LATER. I UNDERSTAND THAT, UPON ACCEPTANCE,
THIS APPLICATION IS BINDING, AND THEREUPON I SHALL BE ELIGIBLE
TO RECEIVE THE SPECIAL PAY DISCUSSED IN REFERENCE (A) AND THAT
THIS SPECIAL PAY WILL BE DISBURSED IN MONTHLY INSTALLMENTS FOR
AS LONG AS I REMAIN IN A QUALIFYING BILLET UP TO THE COMPLETION
OF MY 25TH YEAR OF SERVICE. I UNDERSTAND THAT ANY PAYMENT OF
THIS SPECIAL PAY BEYOND 25 YEARS OF SERVICE IS PROHIBITED BY REF
B.


****   OR   ****

2. (RESERVE OFFICER W/ LESS THAN 24 YEARS OF SERVICE) CONTINGENT
UPON ACCEPTANCE OF MY APPLICATION FOR THIS SPECIAL PAY, I
CONSENT TO SERVE ON ACTIVE DUTY THROUGH THE COMPLETION OF THE
PERIOD OF OBLIGATION. I FURTHER AGREE NOT TO TENDER A REQUEST
FOR RELEASE FROM ACTIVE DUTY THROUGH THE COMPLETION OF THE
PERIOD OF OBLIGATION. I UNDERSTAND THAT, UPON ACCEPTANCE, THIS
APPLICATION IS BINDING, AND THAT THEREUPON I SHALL BE ELIGIBLE
TO RECEIVE PAYMENTS DISCUSSED IN REFERENCE (A). I FURTHER
UNDERSTAND THAT IF, FOR ANY REASON, I DON’T SERVE IN THE BILLET
BEYOND ONE YEAR FROM THE DATE MY APPROVED ELIGIBILITY BEGINS, I
WILL BE RESPONSIBLE FOR A PRO RATA RECOUPMENT OF UNEARNED BONUS
MONEY.

2. (RESERVE OFFICER W/ MORE THAN 24 YEARS OF SERVICE)
CONTINGENT UPON ACCEPTANCE OF MY APPLICATION FOR THIS SPECIAL
PAY, I CONSENT TO SERVE ON ACTIVE DUTY THROUGH THE COMPLETION OF
THE PERIOD OF OBLIGATION WHICH IS ONE YEAR AFTER THE DATE OF
APPROVAL OF MY APPLICATION OR ONE YEAR AFTER THE DATE OF MY
ARRIVAL IN THE QUALIFYING BILLET, WHICHEVER IS LATER. I FURTHER
AGREE NOT TO TENDER A REQUEST FOR RELEASE FROM ACTIVE DUTY
THROUGH THE COMPLETION OF THIS PERIOD OF OBLIGATION. I
UNDERSTAND THAT, UPON ACCEPTANCE, THIS APPLICATION IS BINDING,
AND THAT THEREUPON I SHALL BE ELIGIBLE TO RECEIVE PAYMENTS
DISCUSSED IN REFERENCE (A) AND THAT THIS SPECIAL PAY WILL BE
DISBURSED IN MONTHLY INSTALLMENTS FOR AS LONG AS I REMAIN IN A
QUALIFYING BILLET UP TO THE COMPLETION OF MY 25TH YEAR OF
SERVICE. I UNDERSTAND THAT ANY PAYMENT OF THIS SPECIAL PAY
BEYOND 25 YEARS OF SERVICE IS PROHIBITED BY REF B.


3. THE FOLLOWING INFORMATION IS PROVIDED REGARDING THE BILLET
FOR WHICH I AM APPLYING FOR THE SENIOR SWO CRITICAL SKILLS
RETENTION BONUS:

UIC:
BSC:
EDA:
PRD:
25 YEARS OF ACTIVE SERVICE DATE:
                               (SIGNATURE)


________________________________________________________________
Note: APPLICATIONS SHOULD BE FAXED TO PERS-41 AT (901)874-
2758/2687, DSN 882.