Fillable DATA REQUIRED BY THE PRIVACY ACT (US Army)

Fill Online, Printable, Fillable, Blank DATA REQUIRED BY THE PRIVACY ACT (US Army) Form

Use Fill to complete blank online US ARMY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

DATA REQUIRED BY THE PRIVACY ACT (US Army)

On average this form takes 24 minutes to complete

The DATA REQUIRED BY THE PRIVACY ACT (US Army) form is 4 pages long and contains:

  • 5 signatures
  • 0 check-boxes
  • 75 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your US Army forms online.

BROWSE US ARMY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
3. CURRENT GRADE:
5. CITY: 6. STATE: 7. ZIP CODE:
11. UIC: 12. OFTS Command:
15. UNIT PHONE:: UNIT FAX:
Initials TAB
A
B
(1)
(2)
Weapons Qualification (Authorized Forms are listed in AR 600-8-19 Table 3-7)(Junior Promotion Board only)
(3)
3.A
3.B
3.C
3.D
3.E
3.F
3.G
1
2
3
4
5
Complete this portion only if currently mobilized/deployed.
I am currently mobilized/deployed. A copy of my orders are provided in tab b.
SECTION B - PROMOTION PACKET/FILE FORMAT
13. COMMAND CONVENING BOARD:
I understand that if promoted, I must advise the commander of the position into which I am promoted of any
change in my status or expected REFRAD date.
Packet Composition & Preference Proposed USARC Form
Provide security clearance and date of investigation. (Memorandum)
Voluntary; however, failure to provide the requested information may result in a delay or otherwise adversely impact upon the promotion packet eligibility.
DA Form 3355 Jan 2015 Version, Promotion Points Worksheet (
Junior Promotion Board only
)
Military awards/decorations (letters and/or certificates of commendation, appreciation, or achievement).
SECTION A - SOLDIER AND UNIT INFORMATION
My expected release from active duty (REFRAD) date is:
I understand that if I am released from mobilization under U.S.C. Title 10, Section 12302 and accept a
consecutive extended voluntary active duty for operational support (ADOS) assignment under U.S.C. Title 10,
Section 12301, the position into which I am promoted may be released for fill by another qualified Soldier. Failure
to obtain authorization from the gaining commander may result in a revocation of my promotion (de facto status
not authorized). I also understand that when released from the concurrent voluntary active duty, it is my
responsibility to locate a position for which I am qualified or I will be subject to the overstrength policy in effect at
the time of release from voluntary active duty.
8. SOLDIER'S E-MAIL ADDRESS:
1. NAME (LAST, FIRST MI)
ROUTINE USES:
DISCLOSURE:
2. SSN:
4. SOLDIER'S ADDRESS:
10. UNIT:
My duty location is located in - list state or country:
PAGE 1 OF 3
Promotion Packet Composition, Elections and Preferences
For use of this form, see AR 600-8-19; the proponent agency is DCS, G-1
DATA REQUIRED BY THE PRIVACY ACT
AUTHORITY:
Title 5 USC, Section 301.
To establish packet format and member elections and preferences.
PRINCIPAL PURPOSE:
To specify and certify as correct, the details of a promotion packet format, avenue of elections, preferences, and agreements for an individual member of the Army Reserve.
Copy of all DD Forms 214/215, or NGB 22, as applicable.
Military Academic Reports for all military courses (DA Forms 1059/Certificates of Training). Include proof of all
NCOES completion or waiver as applicable. (All) As last document, include DA Form 7432 Sergeants Major
Academy Administrative Data Sheet for SGM Promotion packets. (Senior)
Copies of NCOERs and/or signed memo from current commander explaining missing report(s). Must include as
a minimum, the last 5 (Copy single sided and file most recent on top in descending order). (Junior)
The following items will be incorporated into the Soldier Promotion Packet if not filed in the Soldiers Army Military
Human Resouce Record (AMHRR).
DESCRIPTION/INSTRUCTIONS
Current copy of DA Forms 2A and 2-1 (all pages) or Record Brief. Data must be updated in the automated
system. Manual changes are authorized only where the data entry permissions level is beyond that authorized for
unit level maintenance. Each page must be "Certified True and Correct" by records custodian. (File 1-5 below in
sequential order under the last page of this form. Do not insert numerical tabs). (Signed by the Soldier.)
Most recent DA Form 705 (for record within 12 months or less of the board convening date), current DA
Form 5500-R/5501-R (within 12 months) or DA Forms 3349 exempting Soldier from APFT, as applicable.
SECTION C - MOBILIZED/DEPLOYED SOLDIERS
Proof of all civilian education (Junior) / highest level Obtained (Senior).
Current or pending Mobilization/Deployment Orders (file in sequential order with most current on top).
Letter to President of the Board (if applicable) should be filed following the last page of this checklist. Letters may
address missing information such as NCOER's/Awards and only be signed by the Soldier. No letters of
recommendation from the chain of command are authorized.
File the specific items and forms listed below/under the specified tab. All documents should be filed in descending date order with
the most current on top. Relative dates are calculated as of the convene date of the board. Documents with dated requirements
such as APFT, Ht/Wt, physicals, etc., must be current as of the convene date of the board. Documents with data on the reverse
side should be photocopied either as two separate pages or as a two-sided, head-to-foot copy.
Official Photograph. (See AR 640-30. Exempt if deployed into area where official facilities are unavailable.) Affix
the photo to a blank sheet of white paper. Omit HT/WT info and Commander's Signature. DA Form 2A will be
used to validate height/weight. (Senior Promotion Board only)
NOTE: THIS DOCUMENT MUST BE INCLUDED AS THE COVER SHEET FOR THE PROMOTION PACKET. FIX FORM TO TOP OF DOCUMENTS INSIDE A MANILA FOLDER.
14. UNIT POC:
INITIALS
1.
2.
a.
b.
c.
d.
e.
e.1
f.
Initials
a.
b.
/ (1) Drill Sergeant - SQI "X" / (4)
Other ASI/SQI (Other than Nominative)
/ (2) Instructor - SQI "8" / (5) Observer/Controller
/ (3) / (6) Nominative (IG, EO, SROTC etc.)
Initials
c.
(1)
(2)
Indicate below if employed as an Army Reserve civilian employee with a dual status condition of employment.
I understand that I incur a 1-year position obligation to report to and serve in the duty position into which promoted
before voluntary reassignment. I understand that the first General Officer of the position to which I am promoted
is the only authority to waive any portion of the 12-month position obligation and can only do so after I have been
reassigned to the position into which promoted. (Junior Promotions only) I also understand that I incur a 12
month service remaining requirement which is calculated from the effective date of promotion. (SSG Only)
I agree to travel _______________ (50, 75, 100, 125, 150, etc.) miles from my residence to serve in the duty
position to which I am promoted. I understand that I may be promoted and reassigned into any duty position for
which I am qualified within the distance of miles selected based on the needs of the Army. Failure to list mileage,
initial statement, and sign this document means I will only be promoted if a position for which I qualify is available
within 50 miles (limited to 90 minutes total one way commuting time) from my home of residence (See AR 140-
10).
I understand that it is my responsibility to verify that the gaining duty position is within the boundaries established
by the conditions of my civilian employment. If not, it is my responsibility to notify my promotion authority
immediately.
I understand that if I accept promotion, I agree to comply with a reassignment order or my promotion orders may
be revoked, funds based on the higher rank recouped, and I will be removed from the promotion list.
I understand that if I have not already completed the required training, I must complete the appropriate training
within the timeframe prescribed by current policy from my promotion effective date, I may be required to attend
the required training in lieu of annual training, and unless a waiver is approved by the promotion authority failure
to do so will result in involuntary reassignment and/or reduction in grade as applicable in accordance with
regulatory guidance and current policy.
I understand that if I am mobilized or deployed and cannot be immediately reassigned to the gaining unit, I must
ensure reassignment orders are published and I must report to the gaining position no later than the 91st day
after release from mobilization. Failure to do so, may be deemed as a declination in which case my promotion
orders may be revoked and all funds received based on the higher rank may be recouped.
SECTION E - EXCEPTIONS
I do not wish to be promoted into positions requiring additional training identified below.
I understand that if I do not decline promotion within 90 days of the effective date of promotion and/or do not
request reassignment orders to report within 90 days of release from mobilization, my orders will be revoked, all
funds based on the higher grade will be recouped and I will be removed from the promotion list.
Initials are mandatory for each item below if selections were made in 2b above.
2. DUTY POSITIONS WITH ADDITIONAL TRAINING OBLIGATION
I understand that I will be considered for promotion in my Primary, Secondary and Additional MOS based on
qualificaiton and needs of the Army. If I am no longer qualified to perform in either MOS, I understand I must
initiate action to withdraw the MOS prior to promotion consideration.
SECTION F - PROMOTION PREFERENCES, AGREEMENTS AND UNDERSTANDING
I understand that if promoted into an MOS immaterial position, I will not be awarded the duty MOS, but will be
considered MOS qualified based on my primary MOS.
INITIALS
DESCRIPTION
1. MILEAGE, ASSIGNMENT & OBLIGATION
Military Technician (MT) (excludes MTs with a hire date before 2 Dec 95, AMSA, ECS & ASF personnel).
SECTION D - ARMY RESERVE MILITARY TECHNICIANS
INITIALS
DESCRIPTION
I understand the provisions in Chapter 5, Section II 5-22 and 5-23 - Special Promotions, the exception to decline
promotion based on civilian employment or instructor/drill sergeant status does not apply for promotion outside
my normal convening authority area under the No Geographic Limits policy.
First Sergeant - SQI "M" (SFC ONLY)
I request consideration for promotion into duty positions I have initialed below. I understand that while this will
increase my chance of getting promoted, I will also incur an additional training obligation if not already qualified.
Initial beside each special duty position type below for which you request consideration.
I prefer assignment in an instructor or drill sergeant (Circle one) position. If no instructor/drill sergeant position
is available at my sequence number, I do or do not (Circle one) wish to be promoted into a non instructor or drill
sergeant position. If I elected "do not" I will not be offered a non instructor/drill sergeant position and will remain
on the promotion list until promoted or administratively removed.
Initials/Number according to preference
I understand that I incur a 36 month service remaining requirement from the effective date of promotion. I
understand I must report for the duty position to which promoted and comply with any reassignement orders
issued. Promotion and reassignment will be revoked if I fail to decline a promotion based on a concurrent
reassignment and refuse to comply with the reassignment order or fail to meet the service remaining requirement.
Transfers of TPU Soldiers serving under a promotion service remaining requirement must be approved by the first
general officer in the chain of command to preclude reduction or revocation of the promotion. (Senior
Promotions)
(3)
5. DATE SIGNED:
PAGE 2 OF 3
4. SOLDIER'S SIGNATURE:
3. SOLDIER'S PRINTED NAME:
Packet Composition & Preference Proposed USARC Form
I understand that if I made elections above, but did not initial items in this section and sign below, I will not be
considered for promotion into any positions requiring additional training.
click to sign
signature
click to edit
Initials
SSG
SFC
MSG
SGM
Initials
(1)
(2)
b. RANK/GRADE: c. SIGNATURE: d. DATE:
b. RANK: c. SIGNATURE: d. DATE:
b. RANK: c. SIGNATURE: d. DATE:
b. RANK: c. SIGNATURE: d. DATE:
a. COMMANDER'S PRINTED NAME:
I understand that if recommended by the promotion board, I will remain on the promotion list unless
administatively removed (Junior Promotions) or 24 months from the board date (Senior Promotions Only). I
will be promoted within my sequence number into the next vacancy for which I am qualified provided I am in a
promotable status. If no vacancy becomes available, I will be administratively removed from the selection list 24
months from the board date (Seniors Only).
I have completed (circle highest level applicable): WLC(BLC) BNCOC(ALC) ANCOC(SLC) SMC
4. FIRST SERGEANT
I have reviewed the entire promotion packet and I certify that to the best of my knowledge, the contents of the packet are accurate,
complete and posted to iPERMs, and all data elements reflected in this packet with permissions at this level are current and
accurate. I have verified that each applicable item has been initialed and each page of this document is signed. My signature
indicates that I verified this Soldier understands the obligations incurred if promoted.
a. FIRST SERGEANT'S PRINTED NAME:
SECTION H - SOLDIER, RECORDS CUSTODIAN AND COMMANDER VERIFICATION
I have reviewed the entire promotion packet and I certify that to the best of my knowledge, the contents of the packet are accurate,
complete and posted to iPERMs, and all data elements reflected in this packet with permissions at this level are current and
accurate. I have verified that each applicable item has been initialed and each page of this document is signed. My signature
indicates that I verified this Soldier understands the obligations incurred if promoted.
Packet Composition & Preference Proposed USARC Form
I understand that according to regulatory guidance, it is my responsibility to compile, review, complete and submit this Soldier's
promotion packet to the appropriate promotion authority. I have ensured this Soldier's data, records and promotion packet are
accurate according to the records that I have available. I have also ensured the contents of the packet are accurate, complete and
posted to iPERMs, and all data elements reflected in this packet with permissions at this level are current and accurate.
3. SOLDIER.
a. RECORDS CUSTODIAN'S PRINTED NAME:
a. SOLDIER'S PRINTED NAME:
I have reviewed the entire promotion packet and I certify that to the best of my knowledge, the contents of the packet are accurate,
complete and posted to iPERMs, and all data elements reflected in this packet with permissions at this level are current and
accurate. I have verified that each applicable item has been initialed and each page of this document is signed. My signature
indicates I understand and agree to the obligations incurred if promoted. I also understand that without my signature on this form,
all elections will be considered as "No" and my geographic region will be limited to the maximum authorized for involuntary
assignments (Limited to 50 miles/90 minutes).
PAGE 3 OF 3
5. COMMANDER.
2. RECORDS CUSTODIAN.
(3) ANCOC (SLC)
To the rank of:
1. Waivers.
SECTION G - WAIVERS
(1) WLC
NO WAIVERS AUTHORIZED
1. SOLDIER UNAVAILABLE/STATUS/REMARKS:
(4) SMA
May be conditionally promoted based upon completion of the
Sergeant Major Academy (SMA).
Waiver Required for consideration:
(2) BNCOC (ALC)
2. Noncommissioned Officer Education System Requirement.
I understand that as a minimum completion of Structured Self Development(SSD) 1 is a requirement for
Promotion Consideration and Pin on to SGT. WLC or BLC and SSD 2 or WLC and Advanced Leaders Course
Common Core is a requirement for promotion consideration and pin on to SSG./ ALC or BNCOC and SSD3 is a
requirement for Promotion Consideration and Pin on to SFC/ANCOC or SLC and SSD4 is a requirement for
Promotion Consideration and Pin on to MSG.
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

DATA REQUIRED BY THE PRIVACY ACT (US Army)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document