PRESEPARATION COUNSELING CHECKLIST
FOR RESERVE COMPONENT SERVICE MEMBERS RELEASED FROM ACTIVE DUTY
(Please read Privacy Act Statement below before completing this form.)
SECTION I - PRIVACY ACT STATEMENT
AUTHORITY: 10 USC 1142, E.O. 9397.
PRINCIPAL PURPOSE(S): To record preseparation services and benefits requested by and provided to Service members; to identify
preseparation counseling areas of interest as a basis for development of an Individual Transition Plan (ITP). The signed preseparation
counseling checklist will be maintained in the Service member's official personnel file. Title 10, USC 1142, requires that not later than 90 days
before the date of separation, preseparation counseling for Service members be made available.
ROUTINE USE(S): None.
DISCLOSURE: Voluntary; however, it will not be possible to initiate preseparation services or develop an Individual Transition Plan (ITP) for a
Service member if the information is not provided.
SECTION II - PERSONAL INFORMATION (To be filled out by all applicants)
1. NAME (Last, First, Middle Initial)
4. SERVICE (X one)
5. PLACE OF RELEASE FROM ACTIVE DUTY
Army National Guard
Marine Corps Reserve
6. ANTICIPATED DATE OF RELEASE
7. DATE CHECKLIST PREPARED
Air National Guard
Air Force Reserve
FROM ACTIVE DUTY (YYYYMMDD)
Coast Guard Reserve
SECTION III. ALL TRANSITIONING SERVICE MEMBERS MUST READ INSTRUCTIONS, SIGN AND DATE.
a. Items checked "YES" are mandatory for Service member to receive further information or counseling, or attend additional workshops,
briefings, classes, etc. Service members that check "YES" in Item 11.a. will be released by Commanders to attend the appropriate
workshop, briefing, etc. in its entirety, if Service member has sufficient time remaining on active duty and attendance can be accomplished
prior to completion of demobilization out-processing.
b. Shaded Areas: Areas that are shaded mean (1) the information is not applicable or (2) the information is referring to a Web site address
and the URL requires no explanation. For example: 11.b. is shaded under SPOUSE because DD Form 2586 does not apply to spouses.
Items 11.f.(1) and (2) are shaded because they refer to Web site addresses and they require no explanation.
c. I was offered preseparation counseling on the above date (Item 7) on my transition benefits and services as appropriate. I understand that
this preseparation counseling is provided to assist my transition process as required by Title 10, USC, Chapter 58, Section 1142.
d. I have checked those items where I desire further information or counseling. I have also been advised where to obtain assistance in
developing an Individual Transition Plan (ITP).
decline (X appropriate block) preseparation counseling. (If you check the "decline" box, you are declining
preseparation counseling only on those items on this checklist where you have the option of declining.) Sign and date the checklist.
8a. SERVICE MEMBER SIGNATURE
b. DATE (YYYYMMDD)
9a. TRANSITION COUNSELOR SIGNATURE
b. DATE (YYYYMMDD)
SECTION IV. Please indicate (by checking YES or NO) whether you (or your spouse if applicable) desire counseling for the following services
and benefits. All benefits and services checked YES should be used in developing your ITP. The following services and benefits are available
to all Service members, unless otherwise specified:
10. EFFECTS OF A CAREER CHANGE
11. EMPLOYMENT ASSISTANCE
a. Dept. of Labor sponsored Transition Assistance Workshops and
Service sponsored Transition Seminars/Workshops
b. Use of DD Form 2586 (Verification of Military
Experience and Training)
(1) Do you want a copy of your Verification of Military
Experience and Training (VMET) Document? If yes, go to
to print your VMET
document and cover letter.
c. DoD Job Search Web site
d. Transition Bulletin Board (TBB) and Public and Community
e. Teacher and Teacher's Aide Opportunities/Troops to Teachers
f. Federal Employment Opportunities
g. Hiring Preference in Non-Appropriated Fund (NAF) jobs
(Eligible Involuntary Separatees)
h. State Employment Agencies/America's Job Bank
i. Reemployment Rights
j. Employer Support for Guard and Reserve (ESGR)
k. Career One Stop
DD FORM 2648-1, JUN 2005
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