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Are you (or your spouse) separating/have you separated from active duty military service in southern California (San Diego, Riverside, Imperial or Orange counties)?

From what location/installation are you separating/did you separate from active duty service?

Where do you plan to reside after separation?

Other: Plan to reside

First Name:

Last Name:

Email address (please do not use your military email)

(non-military Email)

Phone number:

Current Address: Street

Please do not use a PO Box or APO/FLO

City

State

Zip

Identified gender?

Ethnicity

Where did you hear about zero8hundred?

Social Media, Base Advertising or Other: please specify

Please choose the role that best describes you.

With which branch of service are you currently associated?

Other: please specify

Are you separating or retiring?

What is your rank?

Are you prior enlisted?

What is your current or anticipated discharge status?

What is the month and year of your separation/retirement date from active duty? (MM/YYYY format only please)

(MM/YYYY)

What is your date of birth?

(DD/MM/YYYY)

What is your marital status?

How many children do you have under the age of 18?

What is your highest education level?

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Thank you for allowing zero8hundred to say more than just a "Thank You for Your Service." One of our staff will contact you after you schedule your Introductory Call. If you do not receive a confirmation email, please check your spam folder.