DA 4187-Stabilization - Attachments Menu PERSONNEL ACTION...

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Unformatted text preview: Attachments Menu PERSONNEL ACTION For use of this form, see PAM 600-8; the proponent agency is DCS, G-1. DATA REQUIRED BY THE PRIVACY ACT OF 1974 Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended AUTHORITY: PRINCIPAL PURPOSE: To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8. ROUTINE USES: DISCLOSURE: The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may apply to this system. Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the request for personnel action. 1. THRU (Include ZIP Code) 2. TO (Include ZIP Code) 3. FROM (Include ZIP Code) COMMANDER: HHBN, 10th MTN DIV (LI) FORT DRUM NY, 13601 COMMANDER Human Resources Command ATTN: AHRC-(BRANCH) FORT KNOX, KY 40122-5206 COMMANDER: LFS, HHBN, 10th MTN DIV (LI) FORT DRUM NY, 13601 SECTION I - PERSONAL IDENTIFICATION 5. GRADE OR RANK/PMOS/AOC 4. NAME (Last, First, MI) SNUFFY, JOE 6. SOCIAL SECURITY NUMBER E-4/SPC/11B1O 123-45-6789 SECTION II - DUTY STATUS CHANGE (AR 600-8-6) 7. The above Soldier's duty status is changed from to effective hours, SECTION III - REQUEST FOR PERSONNEL ACTION 8. I request the following action: (Check as appropriate) Service School (Enl only) Special Forces Training/Assignment Identification Card ROTC or Reserve Component Duty On-the-Job Training (Enl only) Identification Tags Volunteering For Oversea Service Retesting in Army Personnel Tests Separate Rations Ranger Training Reassignment Married Army Couples Leave - Excess/Advance/Outside CONUS Reassignment Extreme Family Problems Reclassification Change of Name/SSN/DOB Exchange Reassignment (Enl only) Officer Candidate School Other (Specify) Airborne Training Asgmt of Pers with Exceptional Family Members 9. SIGNATURE OF SOLDIER (When required) Ranger Stabilization 10. DATE (YYYYMMDD) SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet) 1. IAW AR 614-200 paragraph 5-4, SM requests to be stabilized at Fort Drum NY, 13602 for one year following completion of Ranger School. 2. The following is provided Soldiers Full Name:________________ SSN:___________ Proposed Graduation Date:______ 3. SM is not flagged IAW AR 600-8-2 and meets height and weight standards IAW AR 600-9. Encls: - ERB/ORB - Letter from school with projected graduation date of: SECTION V - CERTIFICATION/APPROVAL/DISAPPROVAL 11. I certify that the duty status change (Section II) or that the request for personnel action (Section III) contained herein HAS BEEN VERIFIED RECOMMEND APPROVAL 12. COMMANDER/AUTHORIZED REPRESENTATIVE RECOMMEND DISAPPROVAL 13. SIGNATURE IS APPROVED IS DISAPPROVED 14. DATE (YYYYMMDD) Travis J. Boudreau CPT, IN, CMD DA FORM 4187, MAY 2014 SUPERSEDES DA FORM 4187, JAN 2000 AND REPLACES DA FORM 4187-1-R, APR 1995 Page 1 of 2 APD LC v1.03ES Attachments Menu 15. NAME OF INDIVIDUAL a. TO ADDENDUM - RECOMMENDATIONS FOR APPROVAL/DISAPPROVAL b. FROM COMMANDER HHBN, 10th MTN DIV (LI) FORT DRUM NY, 13601 AUTHORITY c. ACTION: 16. SSN APPROVED DISAPPROVED COMMANDER LFS, HHBN, 10th MTN DIV (LI) FORT DRUM NY, 13601 APPROVAL RECOMMEND: d. NAME (Last, First, Middle) e. RANK GASKIN, CEDRIC D. LTC g. TITLE/POSITION h. SIGNATURE DISAPPROVAL f. DATE (YYYYMMDD) BATTALION COMMANDER i. COMMENTS AUTHORITY c. ACTION: a. TO b. FROM DCGO: 10th Mountain Division (LI) Fort Drum NY, 13601 COMMANDER: HHBN, 10th MTN DIV (LI) FORT DRUM NY, 13601 APPROVED DISAPPROVED APPROVAL RECOMMEND: d. NAME (Last, First, Middle) e. RANK BRUNSON, XAVIER T. BG g. TITLE/POSITION h. SIGNATURE DISAPPROVAL f. DATE (YYYYMMDD) DEPUTY COMMANDER i. COMMENTS a. TO b. FROM AUTHORITY c. ACTION: APPROVED DISAPPROVED APPROVAL RECOMMEND: d. NAME (Last, First, Middle) e. RANK g. TITLE/POSITION h. SIGNATURE DISAPPROVAL f. DATE (YYYYMMDD) i. COMMENTS a. TO b. FROM AUTHORITY c. ACTION: APPROVED DISAPPROVED RECOMMEND: d. NAME (Last, First, Middle) e. RANK g. TITLE/POSITION h. SIGNATURE APPROVAL DISAPPROVAL f. DATE (YYYYMMDD) i. COMMENTS DA FORM 4187, MAY 2014 Page 2 of 2 APD LC v1.03ES ...
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