To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8.
Leave - Excess/Advance/Outside CONUS
Change of Name/SSN/DOB
DATA REQUIRED BY THE PRIVACY ACT OF 1974
SECTION I - PERSONAL IDENTIFICATION
SECTION V - CERTIFICATION/APPROVAL/DISAPPROVAL
7. The above Soldier's duty status is changed from
SECTION III - REQUEST FOR PERSONNEL ACTION
IS APPROVEDRECOMMEND APPROVAL IS DISAPPROVEDRECOMMEND DISAPPROVAL
SUPERSEDES DA FORM 4187, JAN 2000
AND REPLACES DA FORM 4187-1-R, APR 1995
DA FORM 4187, MAY 2014
HAS BEEN VERIFIED
Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended
The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may
apply to this system.
5. GRADE OR RANK/PMOS/AOC 6. SOCIAL SECURITY NUMBER
Special Forces Training/Assignment
Retesting in Army Personnel Tests
Reassignment Married Army Couples
Officer Candidate School
Asgmt of Pers with Exceptional Family Members
ROTC or Reserve Component Duty
Volunteering For Oversea Service
Reassignment Extreme Family Problems
12. COMMANDER/AUTHORIZED REPRESENTATIVE 13. SIGNATURE
For use of this form, see PAM 600-8; the proponent agency is DCS, G-1.
11. I certify that the duty status change (Section II) or that the request for personnel action (Section III) contained herein -
SECTION II - DUTY STATUS CHANGE (AR 600-8-6)
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
8. I request the following action: (Check as appropriate)
4. NAME (Last, First, MI)
2. TO (Include ZIP Code)
3. FROM (Include ZIP Code)
1. THRU (Include ZIP Code)
On-the-Job Training (Enl only)
Service School (Enl only)
Exchange Reassignment (Enl only)
9. SIGNATURE OF SOLDIER (When required) 10. DATE (YYYYMMDD)
14. DATE (YYYYMMDD)
Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the
request for personnel action.
APD LC v1.03ES
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75th Ranger Regiment
Ft. Benning, GA 31905
1600 Spearhead DIV AVE
Fort Knox, KY 40122
ATTN: "Your Branch Representative"
1. SM requests assignment to 75th Ranger Regiment contingent upon successful completion of RASP.
2. SM is available to attend RASP no earlier than "Date".
3. SM is available to PCS on assignment to the 75th Ranger Regiment no earlier than "Date".
Rater Recommend Approval / Disapproval
By signing below, I certify:
1. This SM's DA Form 705 is accurate and up-to-date
2. This SM can do at least 59x pushups, 69x situps, and 6x pullups
3. This SM can run 5 miles in 40 minutes or less
4. This SM can execute a standard 12 mile ruck march with 35lb rucksack in 3 hours or less
"RATER or BN CDR NAME"
"BDE CDR Name", COL, "BR", CDR
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