Troop School 4187 Example.pdf - Attachments Menu PERSONNEL...

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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) 3. FROM (Include ZIP Code) 2. TO (Include ZIP Code) 4TH SFAB 1890 IRWIN DR, BLDG 1048 FORT CARSON, CO 80913 INDIVIDUAL MILITARY TRAINING BLDG 2422, MISTER STREET FORT CARSON, CO 80913 X TRP, 3-4 SFAB 1848 BARKELEY AVE, BLDG 1853 FORT CARSON, CO 80913 SECTION I - PERSONAL IDENTIFICATION 5. GRADE OR RANK/PMOS/AOC 4. NAME (Last, First, MI) SNUFFY, JOE F. 6. SOCIAL SECURITY NUMBER CPT/O-3/AR OR SFC/E-7/19D43 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) TROOP SCHOOL REQUEST 10. DATE (YYYYMMDD) SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet) COURSE TITLE: TITLE OF THE COURSE (TROOP SCHOOLS SCHEDULE) CLASS NUMBER: 02-20 (TROOP SCHOOLS SCHEDULE) COURSE LOCATION: FORT CARSON, CO START DATE: 9 JAN 20 END DATE: 11 JAN 20 MEETS PREREQUISITES: YES ALTERNATE DATES: CLASS NUMBER: 03-20 START DATE: 10 APR 20 END DATE: 12 APR 20 EMAIL ADDRESS: [email protected] I have personally counseled this Soldier on the location of the class and its start time. The Soldier will report at the prescribed time with the required equipment. The Soldier remains assigned to this unit for the duration of the course. The Soldier is exempt from all duties, appointments and details for the entire period of the course. Changes in attendance will only be made for emergency reasons. POC: SFC Clingempeel, Christopher, [email protected] 719-503-3821 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) JOHN C. AMERICA, MAJ, AR, 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 16. SSN ADDENDUM - RECOMMENDATIONS FOR APPROVAL/DISAPPROVAL 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 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 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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