BERTHING ELIGIBILITY CERTIFICATION

Permanent Drill Site: Navy Operational Support Center Moreno Valley 
 23570 Z St, Riverside CA 92518

Alternate Drill Site (if any): 

1.      NAME (Last, First, MI)

2.      RANK/RATE

3.  SEX
M     F

3.      LAST 4/SSN
 

4.      UNIT UIC:

 
5.      UNIT ASSIGNED 

  Choose a Unit CBMU 303 DET B NCHB 14 FUEL A PHIBCB 1 DET 102 ESU DET 51B OPS SUPP 1939 NSF NWSSB Corona Det. NMCB 17 DET 1517 SURGEMAIN MORVL NWSSB FALLBROOK EOT 1 NFELC SURGE DET A NR OHSU DET D

6.      ADDRESS
                  Street   

City:       Choose State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming    Zip Code:
 

 
8.  PHONE

Home Number including area code:                                 (xxx-xxx-xxxx)

Work Number including area code: (xxx-xxx-xxxx)

Cell Number including area code: (xxx-xxx-xxxx)
 

POC: SUPPLY DEPT              
HOLIDAY INN EXPRESS
TEL 951-656-2024/FAX 6526
TEL 951-243-0075

SUPPLY DUTY PHONE: 951-965-2610            (After working hours)

READ EACH STATEMENT BELOW & CHOOSE "YES" IF YOU AGREE:

    NO YES     I understand that berthing is a privilege and not an entitlement.
 

    NO YES    I certify that the above address is my residence and that I travel 50 miles or more to my permanent drill site.
 

    NO YES    I will perform at least eight hours of scheduled drill on day before, or the day following the use of berthing

           provided, or 4 four-hour drills within a 48-hour period.
    NO YES    I will sign-up or call supply for berthing reservation. The last day to call is one week prior to drill weekend.

    NO YES   The Reserve center will only pay for the room. The use of hotel phones, cable tv, parking fees, and other

          extra services will be paid by the individual.
    NO YES   I understand the last day to cancel a room is 24 hours prior. Failure to cancel reservation in a timely manner

          will result a “NO SHOW’s (First no-show will be given a written warning, Second results in suspension of berthing           
          privileges for three months Third time will result in a suspension of one year).
 

    NO YES    I understand if a berthing reservation is made and I am subsequently found ineligible, (i.e. not meeting the

           eligibility requirements per COMNAVRESFOR P4000.1B, I will be liable for reimbursing the Navy for the cost of the 
           contracted room.
 

 
11.    Electronic Signature (Type full name or initials)

 
12.  Date  (will be noted on submission)

Your Email:

Note:  This form must be completed and returned to the supply/Logistics Officer the month prior to the drill.  In the event that a reservation must be cancelled, you must notify the Supply/Logistics Office by Wednesday noon prior to the drill.