Da Form 4187/da Form 31 - Agr Enlisted Active Federal Service Retirement Page 2
ADVERTISEMENT
1
2
3
4Circle the appropriate copy designator
Copy 1
Copy 2
Copy 3
Copy 4
PERSONNEL ACTION
For use of this form, see AR 600-8-6 and DA PAM 600-8-21; the proponent agency is ODCSPER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
Title 5, Section 3012; Title 10, USC, E.O 9397.
PRINCIPAL PURPOSE: Used by soldier in accordance with DA PAM 600-8-21 when requesting a personnel action on his/her own behalf
(Section
III).
ROUTINE USES:
To initiate the processing of a personnel action being requested by the soldier.
DISCLOSURES:
Voluntary. Failure to provide social security number may result in a delay or error in processing of the request for
personnel action.
1. THRU (Include ZIP Code)
2. TO (Include ZIP Code)
3. FROM (Include ZIP Code)
Commander, HRC-STL
Cdr, Group/Battalion
ATTN: AHRC-ARE
Current Assignment
Cdr, RSC/Division
1 Reserve Way
St Louis, MO 63132-5200
SECTION I - PERSONAL IDENTIFICATION
4. NAME (Last, First, MI)
5. GRADE OR RANK/PMOS/AOC
6. SOCIAL SECURITY NUMBER
DOE, MARIE J.
SSG/42A3P
111-11-1111
SECTION II - DUTY STATUS CHANGE (AR 600-8-6)
to
7. The above soldier’s duty status is changed from
effective
hours,
19
SECTION III - REQUEST FOR PERSONNEL ACTION
8. I request the following actions: (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 Overseas 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
X
Other (Specify)
Airborne Training
Asgmt of Pers with Exceptional Family Members
VOLUNTARY RETIREMENT
9. SIGNATURE OF SOLDIER (When required)
10. DATE (YYYYMMDD)
SOLDIERS SIGNATURE
CURRENT DATE
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
1. Request voluntary retirement for at least 20 years active service (AS), per AR 635-200, chapter 12.
- 1 -2. My desired date of retirement is:
____________________________________________
(MUST be first day of month)
3. Transition Point of choice is:
___________________________________
(I understand I am only entitled to
reimbursement for travel for closest transition point)
4. Number of days accrued leave:
____________________________________________
(as of last day of separation month)
5. Number of days Permissive TDY:
________________________________________
(AR 600-8-10, Leaves and Passes)
6. Number of days Total Transitional Leave:
_________________________________
(AR 600-8-10, Leaves and Passes)
7. Current Home address/telephone: _________________________________________________________________________
8. Current Duty address/telephone:
_________________________________________________________________________
9. I understand that I must schedule a mandatory pre-retirement counseling at least 120 days out of my desired retirement
date.
10. I read and understood AR 635-200, chapter 12. ______ (Your Initials)
DA Form 31 (Request and authority for Leave) and DA Form 2339 (Application for Voluntary Retirement) is attached.
(if forwarding request directly to ARADMD you must provide a copy through your chain of command)
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)
LOCAL COMMANDERS SIGNATURE BLOCK ONLY
LOCAL COMMANDERS SIGNATURE ONLY
CURRENT DATE
DA FORM 4187, JAN 2000
PREVIOUS EDITIONS ARE OBSOLETE
USAPA V1.00
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business