Reenlistment Request Form

Download a blank fillable Reenlistment Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Reenlistment Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

**
REENLISTMENT REQUEST FORM
**
TO AVOID POSSIBLE ALLOTMENT OR PAY INTERRUPTIONS,
NAVADMIN 284/97
REQUIRES THAT MBR MUST REENLIST NLT 30 DAYS PRIOR TO EAOS DATE.
OPNAVINST 1000.23C
REQUIRES THAT ALL REENLISTMENT REQUEST BE AT THE SERVICING PSD
NLT 45
DAYS PRIOR TO EAOS OR DESIRED REENLISTMENT DATE
!*
***************************************************************************************************************
I. MEMBER INFORMATION
Reenlistment Program: STAR.... *.. Yes
/No
*Attach copy of approved OPINS I34 for
STAR
Name: __________________________________________USN/USNR
SCORE........... Yes
/No
Attach
copy of approved SCORE msg
Rate: __________ SSN: _______-_____ -_________
E-mail :____________________________
Guard 2000..** Yes
/ No
**Attach
copy of approved GUARD msg
Phone (work):________________ (home): __________________ Cell :________________________
Benefits of rate Yes
/ No
Duty Station: _______________________________ UIC: __________________
Other (specify) _________________________
Name of Career Counselor:_______________________________ Phone:__________________
Number of years reenlisting:______
Reenlisting Officer’s Full Name/Grade/Br/Class__________________________________________
Selling leave: Yes
/No
Title (
): __________________________________________
If Yes, number of days:***______
C.O., X.O., OIC, DEPT. HD. DIV. OFF.
***Attach copy of current LES
Date of Reenlistment: _______________ Place (City&State)___________________________
SRB Eligible: ****Yes
/ No
****Attach copy of OPINS I51 for SRB
EAOS: __________
PEBD:______________
ADSD: ______________
COMMAND CC E-MAIL address: ______________________________________
ALTERNATE E-MAIL address: _____________________________________
_____________________________________________
(Member’s Signature and Date)
.
***************************************************************************************************************************************
II. 1. Is PTS required for the member? Yes / No / N/A
2. If yes, has PTS been approved? Yes / No / N/A
Note: For PTS required personnel, forward copy of certification to support request.
*********************************************************************************************************************************************
III. MEDICAL DEPARTMENT ENDORSEMENT.
( is ) / (is not )
Member met the required physical readiness standard for reenlistment and
qualified to reenlist.
______________________________
_________________________
_______________
Print name, rate of Med. Dept. Rep. ______________________________ Signature and Date _________________________________ Phone: ____________________
************************************************************************************************************************************
IV. DENTAL DEPARTMENT ENDORSEMENT.
( is ) / (is not )
Member met the required physical readiness standard for reenlistment and
qualified to reenlist.
______________________________
_________________________
________________
Print name, rate of Med. Dept. Rep. ________________________________ Signature and Date _________________________________ Phone _____________________
V. COMMAND FITNESS LEADER ENDORSEMENT
( is ) / (is not )
Member met the required physical readiness standard for reenlistment and
qualified to reenlist.
Print name, rate of Med. Dept. Rep. __________________________________ Signature and Date :_________________________________ Phone _____________________
VI. COMMAND ENDORSEMENT
:Note: Reenlistment Request received less than 30 days prior to reenlistment
date/EAOS is considered emergency. A memorandum signed by the CO or XO (by dir) is required to justify the nature of emergency reenlistment before
reenlistment documents can be processed. Utilize DD 2468 on all personnel that are within 120 days prior to PRD or EAOS to state career intentions. This
will help CCCs minimize emergency reenlistment situations.
Recommended:
Yes:____ No ____
_________________________________
(Division LCPO/LPO Signature & date)
Yes:____ No ____
________________________________
(Division Officer Signature & date)
Yes:____ No ____
________________________________
(Department Head Signature & Date)
Yes:____ No ____
________________________________
(Command CC Signature & Date)
Yes:____ No ____
________________________________
(CMC/COB/SEA Signature & Date)
Yes:____ No:____
________________________________
(Executive Officer Signature & Date)
APPROVED
:
Yes:____ No:____
________________________________
(Commanding Officer Signature & Date)
***********************************************************************************************************************************************
V. PERSUPPDET PEARL HARBOR REENLISTMENT SECTION
Date request received ___________________.
Reenlistment Representative's Initial: __________________
***********************************************************************************************************************************************
PRIVACY ACT STATEMENT:
The information requested on this form will be used for the sole purpose of processing reenlistment requests. Disclosure of the requested
information is voluntary, however, non-disclosure will result in non-processing of this request.
PERSUPPDET PEARL HARBOR FORM 1160/1(Rev 07/12)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go