Form Ftngd-Os - Full Time National Guard Duty For Operation Support
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1Full Time National Guard Duty for Operation Support (FTNGD-OS)
Packets must be submitted at least 10 days prior to requested start date
Name: Last, First M.
Rank:
SSN:
Military Email:
Current Unit:
Home Phone:
Cell Phone:
Projected Start Date: (DDMMMYYYY)
Projected End Date: (DDMMMYYYY)
Hiring Agency:
Hiring POC:
Phone #:
Packet Received at J1 By:
Date Packet Received at J1 (DDMMMYYYY)
Circle one
New Hire / Roll Over (**)
NOTE: Submit 4187 electronically (not scanned as pdf) and route packet thru BN to DRU and Hiring Agency; Hiring Agency
submits to AGR Branch (ng.la.laarng.mbx.ftngdos-long-tour@mail.mil) for certification; AGR Branch to Hiring Agency or J3
for orders production
UNIT/SOLDIER WILL COMPLETE:
(** documents required for rollover tours)
DA Form 1058-R (Complete all blocks except 34a, b, c, d) **
Is within commuting distance of the assigned duty station. **
Has been counseled on the non-availability of TDY Travel. **
Soldier DOES DOES NOT have future pay orders published or pending in AFCOS that will conflict with entry to
FTNGD-OS tour (AT, ADT, etc).
FTNGD-OS tour will not cause the member to exceed 2190 days (6yrs) and qualify for separation pay.
Soldier
IS
IS NOT
currently flagged from favorable personnel actions.
DA 5960 with supporting dependency documents (marriage license, divorce decree, birth certificates, child custody agreement, etc)**
RPAS (NGB Form 23A)- Within 2 months of start date **
-
No more than 17 years of Active Duty Service
Current Personnel Qualification Record (PQR) and SRB (within 2 months of start date) **
Security Clearance Verification Memo – Within 60 days of start date (ALL Officers. and as required for DMOSQ & by
Hiring Agency for Enlisted)
DA 705 (PT Card) - Within 6 months of start date**
- Height / Weight verified within 30 days (if exceeds table weight must include Body Fat Worksheet)**
MEDPROS Individual Medical Report (IMR) – Must be MR1 or MR2 (exceptions made on case by case basis) **
- HIV within 2 years of start date
- PHA within 1 year of start date
- Copy of DA Form 3349 Permanent Profile – no Temp Profiles Authorized
- Statement of Current Health within 30 days of actual start date **
Pregnancy Test Results - For ALL FEMALE New Hires, a negative result within 15 days of tour start date – The
Pregnancy Test results for packets submitted prior to the 15 day requirement will be submitted prior to start date or
publication of orders will be delayed.
# Accrued Leave Days for Applicants _______; attach current LES **
Current full time manning status (FTM):
AGR
TECH
STATE
FTNGD-OS W/ANOTHER PROGRAM
(Circle One)
NA
______________________________________________________________________
Full Time Military Work Location and Supervisor:
Signatures:
Applicant: __
_______ __ ______________ Date:
_______
JPM-HA Action:
Approved
Disapproved
Returned Without Action
Action Officer/ Date: __________________________
Revised: 5 August 2016
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