Da Form 67-9 - Officer Evaluation Report

ADVERTISEMENT

OFFICER EVALUATION REPORT
FOR OFFICIAL USE ONLY (FOUO)
AR 623-3
SEE PRIVACY ACT STATEMENT IN AR 623-3.
For use of this form, see
; the proponent agency is DCS, G-1.
PART I - ADMINISTRATIVE DATA
DESIGNATED
a. NAME (Last, First, Middle Initial)
b. SSN
c. RANK
d. DATE OF RANK
(YYYYMMDD)
e. BRANCH
/
PMOS (W0)
f.
SPECIALTIES
1LT
12A
LYONS, MICHAEL S.
xxx-x5-4794
20110512
EN
g.1. UNIT, ORG., STATION, ZIP CODE OR APO, MAJOR COMMAND
g.2. STATUS CODE
h. REASON FOR SUBMISSION
1039TH EN CO, MNB TARIN KOWT, APO AE 09380 CENTCOM
MOB
02
Annual
j. RATED
k. NONRATED
l. NO. OF
i. PERIOD COVERED
m. RATED OFFICER'S AKO EMAIL ADDRESS
n. UIC
o. CMD
p. PSB
MONTHS
CODES
ENCL
(.gov or mil)
CODE
CODE
FROM (YYYYMMDD)
THRU (YYYYMMDD)
michael.lyons4@us.army.mil
20120402
20130401
12
0
WX33AA
GB
FS03
PART II - AUTHENTICATION (Rated officer's signature verifies officer has seen completed OER Parts I-VII and the admin data is correct)
a. NAME OF RATER (Last, First, MI)
SSN
RANK
POSITION
SIGNATURE
DATE (YYYYMMDD)
CPT
JACOBS, SETH E.
xxx-x9-1370
COMPANY CDR
20130411
b. NAME OF INTERMEDIATE RATER (Last, First, MI)
RANK
DATE (YYYYMMDD)
SSN
POSITION
SIGNATURE
xxx-x
RANK
c. NAME OF SENIOR RATER (Last, First, MI)
SSN
POSITION
SIGNATURE
DATE (YYYYMMDD)
LTC
RITTER, JACKIE R.
xxx-x8-8567
BATTALION CDR
20130411
BRANCH
E-MAIL ADDRESS (.gov or .mil)
SENIOR RATER TELEPHONE NUMBER
SENIOR RATER'S ORGANIZATION
EN
318-421-6151
jackie.ritter@us.army.mil
HQ, 120th Engineer Battalion
e. SIGNATURE OF RATED OFFICER
DATE (YYYYMMDD)
d. This is a referred report, do you wish to make comments?
Kandahar Airfield, APO AE 09355
20130412
No
Yes, comments are attached
PART III - DUTY DESCRIPTION
AFGHAN NATIONAL ARMY MENTOR TEAM PLATOON LEADER
12A / EN
a. PRINCIPAL DUTY TITLE
b. POSITION AOC/BR
c. SIGNIFICANT DUTIES AND RESPONSIBILITIES. REFER TO PART IVa, DA FORM 67-9-1.
Serves as a Platoon Leader for an Afghan National Army (ANA) Mentor Team in a Mechanized Combat Engineer
Company that executes mobility and survivability missions in support of ISAF operations to enable a Multinational
Force to apply specific mission groups; responsible for the health, welfare, training, readiness and professional
development of assigned personnel; supervises, mentors, and liaisons with all necessary parties to coordinate training,
logistics, and readiness of an ANA company for both partnered and independent operations; advises commander and
staff on the combat readiness and effectiveness of the ANA Route Clearance Company; responsible for the maintenance
and accountability of equipment valued in excess of $8 million dollars.
PART IV - PERFORMANCE EVALUATION - PROFESSIONALISM (Rater)
CHARACTER
Disposition of the leader: combination of values, attributes, and skills affecting leader actions
Yes No
Yes No
a.
ARMY VALUES
(Comments mandatory for all "NO" entries. Use PART Vb.)
1. HONOR:
5. RESPECT:
Promotes dignity, consideration, fairness, & EO
Adherence to the Army's publicly declared code of values
2. INTEGRITY:
6. SELFLESS-SERVICE:
Possesses high personal moral standards; honest in word and deed
Places Army priorities before self
3. COURAGE:
7. DUTY:
Manifests physical and moral bravery
Fulfills professional, legal, and moral obligations
4. LOYALTY:
Bears true faith and allegiance to the U.S. Constitution, the Army, the unit, and the soldier
b. LEADER ATTRIBUTES / SKILLS / ACTIONS:
First, mark "YES" or "NO" for each block. Second, choose a total of six that best describe the rated officer. Select one from
ATTRIBUTES, two from SKILLS (Competence), and three from ACTIONS (LEADERSHIP). Place an "X" in the appropriate numbered box with optional comments in PART Vb.
Comments are mandatory in Part Vb for all "No" entries.
MENTAL
PHYSICAL
EMOTIONAL
b . 1 . ATTRIBUTES (Select 1)
1.
2 .
3.
Fundamental qualities and
Possesses desire, will, initiative, and discipline
Maintains appropriate level of physical
Displays self-control; calm under pressure
characteristics
fitness and military bearing
CONCEPTUAL
INTERPERSONAL
TECHNICAL
b.2 SKILLS (Competence)
1.
2.
3.
Demonstrates sound judgment, critical/creative
Shows skill with people: coaching, teaching,
Possesses the necessary expertise to
(Select 2)
thinking, moral reasoning
counseling, motivating and empowering
accomplish all tasks and functions
Skill development is part of self-
development; prerequisite to action
4. TACTICAL
Demonstrates proficiency in required professional knowledge, judgment, and warfighting
b.3. ACTIONS (LEADERSHIP) (Select 3) Major activities leaders perform: influencing, operating, and improving
COMMUNICATING
DECISION-MAKING
MOTIVATING
INFLUENCING
1.
2.
3.
Method of reaching goals while
Displays good oral, written, and listening skills for
Employs sound judgment, logical reasoning
Inspires, motivates, and guides others toward
operating / improving
individuals / groups
and uses resources wisely
mission accomplishment
PLANNING
EXECUTING
ASSESSING
OPERATING
4.
5.
6.
Short-term mission
Develops detailed, executable plans that are
Shows tactical proficiency, meets mission
Uses after-action and evaluation tools to
accomplishment
feasible, acceptable, and suitable
standards, and takes care of people/resources
facilitate consistent improvement
7.
DEVELOPING
IMPROVING
8.
BUILDING
9.
LEARNING
Long-term improvement in the Army
Invests adequate time and effort to develop
Spends time and resources improving teams,
Seeks self-improvement and organizational
its people and organizations
individual subordinates as leaders
groups and units; fosters ethical climate
growth; envisioning, adapting and leading change
20120621
70
175
YES
PASS
c. APFT:
DATE:
HEIGHT:
WEIGHT:
d. OFFICER DEVELOPMENT - MANDATORY YES OR NO ENTRY FOR RATERS OF CPTs, LTs, CW2s, AND WO1s.
WERE DEVELOPMENTAL TASKS RECORDED ON DA FORM 67-9-1a AND QUARTERLY FOLLOW-UP COUNSELINGS CONDUCTED?
Page 1 of 2
DA FORM 67-9, OCT 2011
PREVIOUS EDITIONS ARE OBSOLETE.
APD PE v1.01ES

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2