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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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.
(Signature of applicant)
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
NO
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
TO
(AD, TTAD, etc.)
DAYS
e. SIGNATURE OF UNIT COMMANDER
f. DATE
35a. NAME OF RECORDS CUSTODIAN ( Last, First, MI)
b. GRADE
c. SIGNATURE
d. DATE
APD PE v1.00ES
REVERSE, DA FORM 1058-R, JUL 2010

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