Fillable Selective Service Form

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Selective Service Form

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Lamar State College – Port Arthur
Selective Service Registration Form
In compliance with House Bill 558 passed during the 76
th
Legislative session, Lamar State
College – Port Arthur requires that all male U.S. citizens from 18 to 26 years of age provide
proof of registration with the Selective System or exemption from such registration, prior to
employment.
Name
Mailing Address
Telephone
Date of Birth
Social Security
1. Are you a male U.S. Citizen who is from 18 to 26 years of age? ____Yes ____No
If no, disregard questions 2 and 3.
If you are a non-immigrant alien, you must provide proof of status.
2. Are you registered with Selective Service? ____Yes ____No
Obtain verification from the following web site and attach it to this form.
https://www.sss.gov/RegVer/wfVerification.aspx
3. Are you exempt from registration with Selective Service? ____Yes ____No
If yes, a copy of your exemption is required.
________________________________________ ___________________
Signature Date
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Selective Service Form

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Completed 3 July 2020

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