MLC DL 4187.pdf - Attachments Menu PERSONNEL ACTION For use...

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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, 1st Training BDE Commander, 350th CACOM Commander, USACAPOC Human Resources Command (HRC) (AHRC-EPF-M) 1600 Spearhead Division Ave Fort Knox, Ky. 40122-5100 Commander, 486th CA BN 7520 W 41st Street Tulsa, OK 74107 SECTION I - PERSONAL IDENTIFICATION 5. GRADE OR RANK/PMOS/AOC 4. NAME (Last, First, MI) RAY COREY ALEBERT 6. SOCIAL SECURITY NUMBER SFC/E7/92Y4O 302-84-8412 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 REQUEST DL MLC SEAT 9. SIGNATURE OF SOLDIER (When required) RAY.COREY.ALBERT.123 5366076 Digitally signed by RAY.COREY.ALBERT.1235366076 Date: 2020.06.09 13:18:20 -04'00' 10. DATE (YYYYMMDD) 20200609 SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet) 1.Course Title: Masters Leaders Course 2.Dates Soldier Unavailable for Training: Jun 20 - Sept 20 3.Are you currently mobilized or deployed: (No) If yes, will command allow attendance at approved training: Yes No (N/A) 4.Current HT/WT: _67 in/174_Date of last APFT _20191115_(PASS) If profile: Permanent (circle)N/A 5.Security Clearance:Yes/Secret 6.Duty Position Title/MOS: SR Supply Sergeant/92Y4O 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) LTC ROBERT L VANDERTUIN 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 16. SSN 302-84-8412 RAY, COREY A. a. TO 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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