SELECTIVE SERVICE VERIFICATION         

        State Law requires all selected male applicants between the ages of 18 and 26 to   
        present proof of having registered with the Selective Service System or to present  
        proof of being exempt from registration prior to beginning State employment.
　    In accordance with State Law, I have verified that

        ______________________

         [Name of Applicant]

       

        [check one]

  　

        OR

　

        Is exempt from registration with the Selective Service System (attach verifying   
        documentation)

        ________________________________

        [Name of Official - please print] [Title]

       

        ________________________________

        [Signature of Official] [Date]