Da Form 4187 - Personnel Action
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PERSONNEL ACTION
For use of this form, see PAM 600-8; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended
AUTHORITY:
PRINCIPAL PURPOSE:
To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8.
The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may
ROUTINE USES:
apply to this system.
Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the
DISCLOSURE:
request for personnel action.
3. FROM (Include ZIP Code)
1. THRU (Include ZIP Code)
2. TO (Include ZIP Code)
CDR,
CDR,
CDR,
1-11IN BN, 1BCT, 3ID
1BCT, 3ID
A CO, 1-11 IN, 1BCT, 3ID
FORT STEWART, GA 12345
FORT STEWART, GA 12345
FORT STEWART, GA 12345
ATTN:BDE S1
SECTION I - PERSONAL IDENTIFICATION
4. NAME (Last, First, MI)
5. GRADE OR RANK/PMOS/AOC
6. SOCIAL SECURITY NUMBER
SECTION II - DUTY STATUS CHANGE (AR 600-8-6)
ABSENT WITHOUT LEAVE (AWOL)
7. The above Soldier's duty status is changed from
to
DROPPED FROM ROLES (DFR)
effective
hours,
SECTION III - REQUEST FOR PERSONNEL ACTION
8. I request the following action: (Check as appropriate)
(Enl only)
Service School
Special Forces Training/Assignment
Identification Card
(Enl only)
ROTC or Reserve Component Duty
On-the-Job Training
Identification Tags
Volunteering For Oversea 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
Other (Specify)
(Enl only)
Officer Candidate School
Exchange Reassignment
Airborne Training
Asgmt of Pers with Exceptional Family Members
9. SIGNATURE OF SOLDIER (When required)
10. DATE (YYYYMMDD)
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
On 21 JAN 2017, PV2 Joe D Schmidlapp failed to report to duty at his unit of assignment; A CO, 1-11IN BN, 1-3ID, Fort Stewart,
Georgia. The Soldier is not on pass or leave and continues to remain AWOL as of 01 MAR 2017.
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)
(Rank, Last, First MI)CPT, IN,COMMANDING
SUPERSEDES DA FORM 4187, JAN 2000
DA FORM 4187, MAY 2014
Page 1 of 2
AND REPLACES DA FORM 4187-1-R, APR 1995
APD LC v1.03ES
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