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Da Form 1058-R - Application For Active Duty For Training, Active Duty For Special Work, Temporary Tour Of Active Duty, And Annual Training For Soldiers Of The Army National Guard And U.s. Army Reserve Page 2

23. REMARKS

I understand that although at the completion of my tour I may be within 2 years of qualifying for an active duty retirement under

10 USC 1293, 3911, or 3914, it is current Army policy that I will be released from active duty at the completion of my tour unless

continued retention on active duty is considered in the best interest of the Army by the Assistant Secretary of the Army (Manpower

and Reserve Affairs) . I hereby consent to my release from active duty at the completion of this tour.

MUST BE SIGNED

(Signature of applicant)

MUST BE COMPLETED

PART II - RECORDS CUSTODIAN

26. PROMOTION

24. PAY ENTRY BASIC DATE

25. SECURITY CLEARANCE

27. DATE OF RANK

CONSIDERATION CODE

30. MANDATORY REMOVAL

28. RYE DATE

31. UIC

29. ETS (Enlisted)

DATE (Officers)

32. HIV TEST DATE

33. PANOGRAPHIC DENTAL X-RAY ON FILE

YES

34. List all previous AD, TTAD, AT, ADT, IADT, and ADSW in the previous and current fiscal year showing inclusive dates, purpose

of tours, and HQ or agency to which attached.

a. PERIOD OF TRAINING/DUTY

b. TYPE TRAINING/

c. LOCATION/

d. DUTY

DUTY

NO.

INSTALLATION

PERFORMED

FROM

(AD, TTAD, etc.)

DAYS

e. SIGNATURE OF UNIT COMMANDER

f. DATE

COMMANDER MUST SIGN

MUST BE DATED

35a. NAME OF RECORDS CUSTODIAN ( Last, First, MI)

b. GRADE

RANK OR GRADE OF

NAME OF UNIT RECORDS CUSTODIAN

RECORDS CUSTODIAN

c. SIGNATURE

d. DATE

SIGNATURE OF RECORDS CUSTODIAN

MUST BE DATED

APD PE v1.00ES

REVERSE, DA FORM 1058-R, JUL 2010

Da Form 1058-R - Application For Active Duty For Training, Active Duty For Special Work, Temporary Tour Of Active Duty, And Annual Training For Soldiers Of The Army National Guard And U.s. Army Reserve Page 2

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