Standardized Extension Worksheet - Attachment 5 (Af Form 1411)
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1Attachment 5:
Standardized Extension Worksheet
Privacy Act of 1974, Authority 10 USC 8012, Secretary of the Air Force powers and duties; delegation by AFI 36-2608,
Military Personnel Records System. Information from this system of record may be disclosed for any use of the Air
Force. If you do not give the required information, it will not be possible to process your request. This worksheet is
utilized to complete the AF Form 1411 and is not a substitute for the AF Form 1411 or AF Form 1089.
Grade/Rank NAME (Last, First, Middle)
SSN
CAFSC
Unit/Deployed Unit
Duty Phone/Deployed
Email Address/Deployed Email
Duty Phone
Address
Home Station (deployed
Unit Commander Name, Email Address and DSN
only)
Reason/Rule for Requested Extension
Rule 1: Qual for Promotion to MSgt, SMSgt & CMSgt
Rule 3: Retire the first day of HYT month
Other:______________________
Rule 9: Pending Completion of MEB
Rule 12: Qual for CONUS or OS PCS, PCA, TDY
Rule 14: Complete Ext to OS Tour-Indef DEROS (DEROS Ext must be approved by AFPC prior to Ext req)
Rule 16: Qual for Retraining or Training (Retraining must be approved prior/Training e.g. ALS/NCOA/SNCOA/OTS etc.)
Rule 29: Post 9-11 GI Bill/TEB Transfer
Leave Sell Election. I elect the following leave sell option on my 1
st
extension: (circle
one):
Note: Only required for first extensions of enlistment and the AF Form 1089 is required
a. Carry for all my leave
b. Cash Settlement for all Accrued Leave
c. Cash Settlement for ______ days
***MPS Use Only***
Authorized
Authorized Selective Reenlistment Bonus/Zone and Multiple
extension months
:
Air Force Reenlistments
Last modified
9 May 2016
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