Form 4126 - Bar To Reenlistment Certificate
Download a blank fillable Form 4126 - Bar To Reenlistment Certificate in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 4126 - Bar To Reenlistment Certificate with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2BAR TO REENLISTMENT CERTIFICATE
For use of this form, see AR 601-280; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AR 601-280 and Executive Order 9397 (SSN) as amended.
AUTHORITY:
PRINCIPAL
To document reasons for recommendation of non- continuation of service pending rehabilitative process. This information
PURPOSE:
becomes part of the subject's military personnel records which are used to document personnel management actions. The
purpose of soliciting the SSN is for positive identification.
Information may be referred to appropriate authorities if disciplinary action or discharge is appropriate. The DoD Blanket
ROUTINE USES:
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 furnish information requested may delay processing the action.
DISCLOSURE:
SECTION I - COMMANDER'S RECOMMENDATION
1.THRU (Soldier being Bared)
2. TO (Next higher CDR)
3. FROM (Initiating CDR)
Under the provisions of AR 601-280, I recommend the Soldier named below be barred from reenlistment in the United States Army for reasons
indicated below and in attached documents (if applicable). Prior to submission of this recommendation, the Soldier was counseled by the
undersigned about his undesirable traits which are the basis for this action and advised of the adverse consequences that may ensue from this
or similar action.
4. NAME (Last, First, Middle)
5. RANK
6. SSN:
7. BAR INITIATION DATE:
8. ETS:
9. DEROS:
10. TAFS ON BAR INITIATION DATE:
DAYS
YEARS
MONTHS
11. MANDATORY REASONS FOR A BAR TO REENLISTMENT
(Supporting documents attached)
a. Un-sat Progress in ABCP
e. Actions Caused Loss of PMOS Qualification (fault of the Soldier)
b. Record APFT Failure (X2)
f. Incident Involving Drugs or Alcohol
c. Removed for cause from NCOES
g. Denied Automatic Integration on the Promotion Standing List
d. UCMJ during Current Term of Service
h. Lost Time During Current Term of Service
Details and description.
12. OTHER REASONS FOR A BAR TO REENLISTMENT
(Supporting documents attached)
Details and description.
15. DATE
13. NAME, RANK AND BRANCH OF COMMANDER
14. SIGNATURE
16. ENCLOSURES
DA FORM 4126, XXX 2014
Page 1 of 2
PREVIOUS EDITIONS ARE OBSOLETE.
APD LCv1.00ES
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business