In War, There Are No Unwounded Soldiers.

We know the effects of today’s economy, along with the growing number of combat veterans returning from Iraq and Afghanistan have made the transition back into civilian life difficult. That’s why Combat Veterans to Careers has teamed up with the local Central Florida community to assist both combat veterans and their families by helping them acclimate into a supportive community and prepare them for a successful career.

If you’d like to receive more information on how CVC can help you and your family, please fill out the form below. Combat Veterans to Careers works with Veterans who served in post-9/11 Iraq or Afghanistan. Verification of service is required. Your information is fully confidential.


Veteran Application

Military Background

Veteran Name*:

Rank*:

Date of Birth*:

MOS/Rate/AFSC*:

Type of Discharge*:

Branch of Service*:
 U.S. Air Force U.S. Army U.S. Coast Guard U.S. Marine Corps U.S. Navy U.S. National Guard/Reserves

Conflict Served In*:
 OIF (Operation Iraqi Freedom) OEF (Operation Enduring Freedom) OND (Operation New Dawn)

Separation Status*:
 Retired Medically Retired Medically Discharged Discharged Reserve Active Duty

Status for Submitted VA Compensation Claim:
 Approved Declined Unknown

Date Separated (if active duty, please provide anticipated date of separation. ) :


Military Separated Rating:

VA Compensation Rating:

(if no rating has been received for VA) Date VA Compensation Claim Submitted:


Personal Information

 Single Married Separated Divorce Widowed

Home Address*:

City*:

State*:

Zipcode*:

Spouse's Name (if married):

Home Phone Number*:

Cell Phone Number:

Email Address*:


Click Here to Add Children

Children:

Name:

Age:

Resides with you:  Yes No

Children:

Name:

Age:

Resides with you:  Yes No

Children:

Name:

Age:

Resides with you:  Yes No

Children:

Name:

Age:

Resides with you:  Yes No


Employment

Desired Career:

Current Position:

Current Employer:

Full Time:
 Yes No
If no then please specify how many hours per week:


Post 9/11 GI Bill Benefits Available:
 Yes No
If Yes, how many months:

Vocational Rehab:
 Yes No


Education

Certifications / Licenses Held:

Are you currently enrolled in school?:
 Yes No

If Yes, name of school:

Course of study:


Emergency Contact Information

Emergency Contact Name*:

Emergency Contact Address*:

Emergency Contact City*:

Emergency Contact State*:

Emergency Contact Zip Code*:

Emergency Contact Email*:

Emergency Contact Home Phone*:

Emergency Contact Cell Phone:

Relationship to Applicant*:


By checking the following box, you acknowledge completion and understanding of each step and process by which shall operate.
 Yes, I acknowledge

 I served in post-9/11 Iraq or Afghanistan.

By checking the following box, you agree to use your E-signature in place of a physical signature, and that your E-signature will stand as your legal signature in any and all respects of the law.*
 I agree to use my E-signature

*Additional Documents

*DD214

*VA Ratings Breakdown

*Picture ID

*Pictures
To select multiple files: 'Ctrl'+Click (windows), 'Cmd'+Click (Mac).

E-Signature*:

Date*:

Security Answer - Please Verify*


*Additional Documents

*VERY IMPORTANT OPSEC Guidelines:

In order for us to process your application, we will need the following documents:

DD214:
This is documents you have received from the Department of Defense or the Veterans Administration. If you have been discharged from service please provide your DD214 that shows category of discharge as well. If you are still on active duty, a scanned copy of your Military ID will suffice.

VA Ratings Breakdown:
Your disability rating should be broken down by category of service connected injuries. Not simply a page that shows what your overall rating is. We need to know what your rating(s) is/are in order to best determine how to assist.

Picture ID:
This can be either a copy of your Military ID, Driver’s License, VA Card, Etc.

Pictures
Minimum of 5 pictures of yourself [include family members, OPTIONAL]

Please provide us with accurate information about yourself so that we can get the assistance you requested to you as soon as possible!
As with all documents of a secure nature, please mark out your social security number, driver’s license number, etc.

WARNING: If you do not provide us with your complete documentation as requested, we will not be able to accept your application!

 

Privacy Note: If you complete this form and share your personally identifying information with Combat Veterans to Careers, we may use your contact information to send further information about our organization or to contact you if necessary. We do not share your information with third parties.


 

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