Fillable APPLICATION FOR USAR ACTIVE GUARD RESERVE (AGR) DUTY (US Army)

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APPLICATION FOR USAR ACTIVE GUARD RESERVE (AGR) DUTY (US Army)

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  • 88 check-boxes
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APPLICATION FOR USAR ACTIVE GUARD RESERVE (AGR) DUTY
(Applicant must read, complete as required, and sign front and back where indicated.)
THIS FORM IS REPRODUCIBLE
DATA REQUIRED BY THE PRIVICY ACT OF 1974
AUTHORITY:
10 USC 12301(d), 10 USC 10211, and 10 USC 10302.
NAME:
(Last, First, Middle)
SOCIAL SECURITY NUMBER: TELEPHONE NUMBER:
(Include Area Code)
HOME BUSINESS
ALIAS/MAIDEN NAME: E-MAIL ADDRESS: CURRENT MAILING ADDRESS: (Street, City, ZIP Code)
SEX: DATE OF BIRTH:
(YYYY-MM-DD)
PLACE OF BIRTH:
(City/State or County)
MARITAL STATUS:
(Check one)
Single
Married Divorced Widowed Separated
NUMBER OF DEPENDENT(S)
ADULTS
CURRENT DUTY STATUS:
(check appropriate boxes)
A
rmy Reserve Unit (TPU)
A
ctive Army Individual Ready Reserve (IRR)
National Guard (TPU) Individual Mobilization Augmentee (IMA) Other (Explain)
RANK: DATE OF RANK: (YYYY-MM-DD) TOTAL NUMBER OF MONTHS TIME IN GRADE:
PEBD:
(YYYY-MM-DD)
ETS:
(Enlisted) (YYYY-MM-DD)
MRD:
(Officer) (YYYY-MM-DD)
BRANCH:
(Officer)
HIGHEST EDUCATION: (Civilian) HIGHEST EDUCATION: (Military)
PRIMARY MOS/AOC: SECONDARY MOS/AOC: ADDITIONAL MOS/FUNCTIONAL AREA:
BASD:
(YYYY-MM-DD) COMMISSION SERVICE DATE:
(YYYY-MM-DD)
NUMBER OF YEARS OF ACTIVE DUTY: SECURITY CLEARANCE:
UNIT NAME OF ASSIGNMENT: UNIT TELEPHONE NUMBER:
(Include Area Code)
UNIT ADDRESS:
Y
OUR ALTERNATE E-MAIL ADDRESS:
AHRC FORM 2370-R, MAR 14 PREVIOUS EDITIONS ARE OBSOLETE
Page 1 of 3
PRINCIPLE PURPOSE:
To determine eligibility and schedule individual for Army Reserve AGR duty.
ROUTINE USES:
To identify the applicant and issue orders. SSN is used to identify the applicant.
Completing this form is mandatory for individuals applying for USAR AGR duty.
Failure to comply will result in nonselection for USAR AGR duty.
DISCLOSURE:
CHILDREN
STATEMENT OF PERSONAL HISTORY AND ACKNOWLEDGMENT OF SERVICE
REQUIREMENTS FOR AGR APPLICANTS
Statement of Personal History
Have you EVER been arrested, cited, charged, investigated, apprehended, or held (civilian and military charges). (Failure to disclose all violations
may be cause to remove your application, rescind, or revoke your assignment orders published.) (Details must be explained on a separate page.)
(If none, write “NONE”)
DATE
(YYYY-MM-DD)
TYPE OF OFFENSE
(Assault, Traffic,
TYPE OF JUDICIAL or NON JUDICIAL or
ADMINISTRATIVE PROCEEDING
DISPOSITION
(Not Guilty, Pending,
SENTENCE IMPOSED
(Probation,
Family member special medical and/or educational requirements are considered when selecting newly assessed AGR Soldiers for assignments.
Special needs constitute care requirements for potentially life-threatening conditions, chronic medical/physical conditions, current and chronic
mental health conditions (6+ months), asthma or other respiratory diagnosis, ADD/ADHD diagnosis, adaptive equipment or assistive technology
device needs, environmental and architectural considerations, and learning disabilities. Once a special need is identified or revealed, the Soldier
is considered for EFMP enrollment. Please divulge any/all Family information pertaining to the above listed categories so proper consideration is
given during the assignment selection process.
Personnel assigned to AGR assignments often represent the community in which they live and work. The actions and activities of the AGR Soldier
and his or her Family are often perceived as representatives of the Army and the Army community. Personnel with serious Family problems or
whose dependents have a history of involvement in unfavorable incidents, which may impair the AGR Soldier's performance of duty or reputation
in the community, are unacceptable for selection as AGR Soldiers. In the space below, provide any information concerning yourself or your
dependents, which may reflect upon your ability to serve in the AGR Program.
ACKNOWLEDGMENT OF SERVICE REQUIREMENTS
I am not under indictment (*information) in any court, nor am I a fugitive from justice or currently serving on probation for any offenses(s).
(*a formal accusation of a crime made by a prosecuting attorney, as distinguished from an indictment presented by the grand jury).
I am not an unlawful user of, or addicted to, alcohol; marijuana; or a depressant, stimulant, or narcotic drug.
I have never been adjudicated as having a mental disorder and have never been committed to a mental institution.
I understand that if I arrive at my initial assignment and fail to meet the requirements for entry into the AGR Program, I will be processed
I understand that prior to being ordered to active duty in the AGR Program, I must meet the medical fitness standards as defined in
Do you have a dependent with the physical, emotional, developmental, or intellectual disorder that requires special treatment, therapy,
http://efmp.amedd.army.mil
to obtain information regarding the Exceptional Family Member Program (EFMP).
AHRC FORM 2370-R, MAR 14
Page 2 of 3
for separation under AR 600-8-24 or AR 635-200.
Chapter 3, AR 40-501. A current physical examination must be completed before assignment to an AGR position.
l understand that providing false information or concealing any disqualifying condition that I know or should know exists at the time of
education, training, counseling, equipment, assistance, or medical care above the level of a general practitioner?
SELECT:
(If none, write"NONE").
(If none, write"NONE")
Found Responsible, etc)
Y
ES NO
entry into the AGR Program may be a basis for adverse action against me. Such action may include judicial action under the provisions
of federal law, including the federal criminal code and Uniform Code of Military Justice, and administrative action, including release from
active duty and elimination from the Ready Reserve.
Dependent(s) require care for the condition of:
Spouse
Daughter Son Other
"I the undersigned, have read and understand all the conditions and service requirements outlined above."
DATE NAME:
SIGNATURE
Please visit:
(Last, First, Middle)
(Visit EFMP website shown below for more information)
DUI, etc)
(Adverse Admin Action, Article 15,
Reprimand, etc)
Confinement, etc)
OF OFFENSE
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signature
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AHRC Form 2370-R, MAR 14
APPLICATION FOR USAR ACTIVE GUARD RESERVE (AGR) DUTY
ADDITIONAL INFORMATION
CURRENT DUTY STATUS (OTHER)
OFFENSE DETAILS
Page 3 of 3
ARMY RESERVE ACTIVE GUARD RESERVE (AGR)
SELECTION ELIGIBILITY CHECKLIST
THIS FORM IS REPRODUCIBLE
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY
10 USC 12301(d), 10 USC 10211, and 10 USC 10302.
To determine eligibility and schedule individual for USAR AGR duty.
To identify the applicant and issue orders. SSN is used to identify the applicant.
Completing this form is mandatory for individuals applying for USAR AGR duty. Failure to comply will result in nonselection for
A
rmy Reserve AGR duty.
Please mark the appropriate response to each question. If you mark the INELIGIBLE block on any of the questions, DO NOT apply unless
you are authorized to request a waiver under Table 2-2, AR 135-18. Waivable requests have been identified with a "W." A request for
ELIGIBLE INELIGIBLE WAIVER
1. Are you currently a member of the U.S. Army Reserve (Ready Reserve)? If you are a member of the Army
National Guard or Active Army, are you willing to accept discharge with a concurrent appointment or enlistment
in the USAR? (AR 135-18, Table 2-1, Rule A)
YES NO NA
2. Are you able to complete a 3-year initial tour of active duty prior to completing 18 years of active service or the
mandatory removal from active status based on age or service (without any extensions) under provision of law or
regulation, as prescribed by current directives. (AR 135-18, Table 2-1, Rule E)
a. If current grade is E4, are you able to complete your initial 3-year tour prior to reaching your RCP of 8 years of
active service. (i.e., as an E4, must have less than 5 years of active service).
YES NO
NO
NO
W
3. Do you meet the retention medical standards of AR 40-501 (physical exam)? (AR 135-18, Table 2-1, Rule C) YES NO NA
4. Are you entitled to and/or in receipt of military retired pay? (AR 135-18, Table 2-2, Rule C)
NO YES W
5. Are you a former USAR AGR participant that was voluntarily released within the last year (from date of
application)? (AR 135-18, Table 2-2, Rule D)
NO YES W
6. Were you involuntarily removed from active duty or full time National Guard, including AGR status, for any
of the following reasons? (AR 135-18, Table 2-3, Rule E)
a. For cause, to include unsuitability or unfitness (other than for temporary medical disability) for military
service,
b. As a result of resignation in lieu of adverse personnel action,
c. As a result of qualitative management program action, or
d. Failure of selection by a tour continuation board. (Table 2-3, Rule E)
NO YES NA
7. Have you been relieved for cause from any duty position, including but not limited to relief from command,
in the 36-month period preceding your date of application for the AGR Program, or the scheduled date of entry
in the AGR Program? (AR 135-18,Table 2-2, Rule G)
NO YES W
8. Have you been involuntarily removed from a unit (Selected Reserve) assignment for any of the following
reasons? (AR 135-18, Table 2-3, Rule F)
a. For cause;
b. On attaining maximum years of service,
c. As a result of qualitative retention board action, or
d. As a result of selective retention board action.
NO YES NA
PRINCIPLE PURPOSE:
ROUTINE USES:
DISCLOSURE:
waiver must be attached to your application, if applicable.
YES
YES
NA
NA
AHRC Form 2370-1-R, MAR 14 (PREVIOUS EDITIONS ARE OBSOLETE)
Page 1 of 2
Authorized Retention Control Point (RCP) as of Feb 14:
b. If current grade is E5, are you able to complete your initial 3-year tour prior to reaching your RCP of 14 years
of active service. (i.e., as an E5, must have less than 11 years of active service).
Note: This rule is applicable to Soldiers that have 20 or more years of credible service towards a Reserve Retirement.
ELIGIBLE INELIGIBLE WAIVER
9. Are you at least 18 years of age and have not reached your 55th birthday? (enlisted only) (AR 135-18,
Table 2-1, Rule B)
YES NO NA
10. Reenlistment Eligibility: (enlisted only) (AR 135-18, Table 2-1, Rule G)
a. Are you eligible for reenlistment or extension per Chapter 2, AR 140-111?
b. Has a Bar to Reenlistment been initiated or in effect? (AR 135-18, Table 2-3, Rule H)
YES
NO
NO
YES
W
NA
11. Do you meet the military education requirements for your grade?
a. As specified in AR 135-18 (Table 2-1, Rule D1a, D2, D3, or D4.)
b. As specified in AR 135-18 (Table 2-1, Rule D1b, 1c, or 1d.)
YES
YES
NO
NO
W
W
12. Are you an officer or warrant officer who has received a referred evaluation report under AR 623-105 in
the 36-month period preceding your date of application for the AGR Program or the scheduled date of entry
in the AGR Program? (AR 135-18, Table 2-2, Rule H)
NO YES W
13. Nonselect for promotion (officer/warrant officer)
a. Were you nonselected on the latest promotion selection board considering the officer active duty list
or warrant officer active duty list? (AR 135-18, Table 2-1, Rule J)
b. Were you a nonselectee on the latest consideration by a mandatory Reserve of the Army promotion
selection board? (AR 135-18, Table 2-3, Rule M)
NO
NO
YES
YES
W
NA
14. Were you promoted by a unit vacancy selection board process less than 1 year prior to the convening
date of the board? (officer only) (AR 140-30, paragraph 3-2c)
NO YES NA
15. Are you under a current suspension of favorable personnel actions (flagged) per AR 600-8-2?
(AR 135-18, Table 2-3, Rule G)
NO YES NA
16. Are you a COL, LTC, CW5, CSM, SGM, PFC, PV2, or PV1?
(OCAR Policy)
NO YES NA
GENERAL QUESTIONS: Answer the following questions that are applicable.
1. Are you a high school graduate or GED recipient? (enlisted only)
2. Are you receiving disability pay? (If yes, you must terminate disability pay prior to entry.)
YES NO
YES NO
3. Were you ever in the AGR Program? YES NO
(Date) (YYYY-MM-DD)
4. Are you married to a service member on active duty? If yes, complete the information in 4a. YES NO
4a. The following is information about my active duty spouse. I understand there is no guarantee of joint domicile.
NAME: RANK:
SSN: BRANCH OF SERVICE:
REVERSE OF AHRC Form 2370-1-R, MAR 14
If yes, when did you leave the program?
Page 2 of 2
"I certify that the above information is true and accurate to the best of my knowledge."
NAME
(Last, First, Middle)
Date SIGNATURE
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APPLICATION FOR USAR ACTIVE GUARD RESERVE (AGR) DUTY (US Army)

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Completed 10 June 2021

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