Da Form 4187 - Personnel Action printable pdf download

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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

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

Da Form 4187 - Personnel Action

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