Da Form 4187 - Personnel Action

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PERSONNEL ACTION
For use of this form, see AR 600-8-6 and DA PAM 600-8-21; the proponent agency is ODCSPER
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
Title 5, Section 3012; Title 10, USC, E.O. 9397.
PRINCIPAL PURPOSE:
Used by soldier in accordance with DA PAM 600-8-21 when requesting a personnel action on his/her own behalf
(Section III).
ROUTINE USES:
To initiate the processing of a personnel action being requested by the soldier.
DISCLOSURE:
Voluntary. Failure to provide social security number may result in a delay or error in processing of the request for
personnel action.
1. THRU (Include ZIP Code)
2. TO (Include ZIP Code)
3. FROM (Include ZIP Code)
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)
7. The above soldier's duty status is changed from
to
effective
hours,
SECTION III - REQUEST FOR PERSONNEL ACTION
8. I request the following action: (Check as appropriate)
Service School
(Enl only)
Special Forces Training/Assignment
Identification Card
ROTC or Reserve Component Duty
Identification Tags
On-the-Job Training
(Enl only)
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
Exchange Reassignment
(Enl only)
Officer Candidate School
Other (Specify)
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)
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)
DA FORM 4187, JAN 2000
PREVIOUS EDITIONS ARE OBSOLETE
USAPA V1.00

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