Da 4187, 2014-05
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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.
The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may
ROUTINE USES:
apply to this system.
Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the
DISCLOSURE:
request for personnel action.
3. FROM (Include ZIP Code)
1. THRU (Include ZIP Code)
2. TO (Include ZIP Code)
HQ, CADET COMMAND
US Army Human Resources Command
Your Command Info
ATTN: Green to Gold, Bldg. 203
ATTN: KNOX-HRC-EPF-A
232 Old Ironsides
1600Spearhead Division Avenue
Ft. Knox, KY 40121
Ft. Knox, KY 40122-5306
SECTION I - PERSONAL IDENTIFICATION
4. NAME (Last, First, MI)
5. GRADE OR RANK/PMOS/AOC
6. SOCIAL SECURITY NUMBER
Your info
Your info
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)
(Enl only)
Service School
Special Forces Training/Assignment
Identification Card
(Enl only)
ROTC or Reserve Component Duty
On-the-Job Training
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
Other (Specify)
(Enl only)
Officer Candidate School
Exchange Reassignment
Age Waiver
Airborne Training
Asgmt of Pers with Exceptional Family Members
9. SIGNATURE OF SOLDIER (When required)
10. DATE (YYYYMMDD)
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
The age limit for participants in Army ROTC is 29 years old; those 30 and above require a waiver. SM will be ______ years old
upon commissioning.
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
RECOMMEND DISAPPROVAL
IS APPROVED
IS DISAPPROVED
12. COMMANDER/AUTHORIZED REPRESENTATIVE
13. SIGNATURE
14. DATE (YYYYMMDD)
Your unit commander
SUPERSEDES DA FORM 4187, JAN 2000
DA FORM 4187, MAY 2014
Page 1 of 2
AND REPLACES DA FORM 4187-1-R, APR 1995
APD LC v1.03ES
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