Draft Da Form 2166-X-Xx - Nco Evaluation Report (Csm/sgm) printable pdf download

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NCO EVALUATION REPORT (CSM/SGM)

SEE PRIVACY ACT STATEMENT

For use of this form, see AR 623-3 and DA PAM 623-3; the proponent agency is DCS, G-1.

IN AR 623-3

PART I – ADMINISTRATIVE DATA

a. NAME

b. SSN

c. RANK

d. DATE OF RANK

e. PMOSC

(Last, First, MI)

f. UNIT, ORG., STATION, ZIP CODE OR APO, MAJOR COMMAND

g. STATUS CODE

h. UIC CODE

i. REASON FOR SUBMISSION

n. RATED NCO’S EMAIL ADDRESS

j. PERIOD COVERED

k. RATED

l. NONRATED

m. NO OF

(.gov or .mil)

MONTHS

CODES

ENCLOSURES

FROM

THRU

(YYYYMMDD)

PART II – AUTHENTICATION

a3. RATER’S SIGNATURE

a1. NAME OF RATER

a2. SSN

a4. DATE

(Last, First, MI)

(YYYYMMDD)

a6. RATER’S EMAIL ADDRESS

a5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

(.gov or .mil)

b3. SENIOR RATER’S SIGNATURE

b1. NAME OF SENIOR RATER

b2. SSN

b4. DATE

(Last, First, MI)

YYYYMMDD)

(

b6. SENIOR RATER’S EMAIL ADDRESS

b5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

(.gov or .mil)

c1. SUPPLEMENTARY

c2. NAME OF SUPPLEMENTARY REVIEWER

c3. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

(Last, First, MI)

REVIEW REQUIRED?

YES

c7. SUPPLEMENTARY REVIEWER’S EMAIL ADDRESS

c4. COMMENTS

c5. SUPPLEMENTARY REVIEWER’S SIGNATURE

c6. DATE

YYYYMMDD)

(.gov or .mil)

(

ENCLOSED?

YES

RATED NCO: I understand my signature does not constitute agreement or disagreement with the assessments of the rater and senior rater. I further understand my signature verifies

that the administrative data in Part I, the rating officials and counseling dates in Part II, the duty description in Part III, and the APFT and height/weight entries in Part IVa and IVb are

correct. I have seen the completed report. I am aware of the appeals process of AR 623-3.

d2. RATED NCO’S SIGNATURE

d1. COUNSELING DATES

INITIAL

LATER

d3. DATE

YYYYMMDD)

(

PART III – DUTY DESCRIPTION

(Rater)

a. PRINCIPAL DUTY TITLE

b. DUTY MOSC