SUBJECT: Request for Continuance on Active Duty
TO: (Proper addressee in para 6 -7)
If I am determined unfit because of physical disability, I,
(name) , hereby apply for
continuance on active duty. I apply for assignment to duties that I am able to perform within
the limitations imposed by my physical disabilities. I request continuance instead of
immediate evaluation and processing for disability retirement or separation action.
I also understand that--
a. I must be able to maintain myself in a normal military environment without the
environment adversely affecting my health or requiring excessive medical care.
b. My disabilities will be periodically reevaluated to decide whether further
continuance on active duty would be in the best interests of the Government or me.
c. Should I later incur a service obligation, I remain liable to complete such obligation
in spite of my condition. Only when I become so disabled that I am no longer able to
perform duty with proper limitations am I no longer liable.
d. At the time of my final retirement or separation from active duty, I will be evaluated
under the regulations then in effect and I may be found fit.
e. I will not be separated without proper examination and physical disability
I request consideration for assignment to one of the following installations. (I have listed
three in the order of my preference.)
(Grade and SSN)
Figure 5-3. Application for continuance on active duty.