PERSONNEL ACTION
To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8.
Identification Card
Identification Tags
Separate Rations
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
to
effective hours,
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
AUTHORITY:
PRINCIPAL PURPOSE:
DISCLOSURE:
Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended
ROUTINE USES:
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
Reclassification
Officer Candidate School
Asgmt of Pers with Exceptional Family Members
ROTC or Reserve Component Duty
Volunteering For Oversea Service
Ranger Training
Reassignment Extreme Family Problems
Airborne Training
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)
Other (Specify)
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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Commander, HRC
ATTN: AHRC-ORD-A
1600 Spearhead Division Avenue
Ft Knox, KY 40122-5204
I request an exception for (enter issue) in order to apply for OCS. I exceed (enter issue) and would therefore require a waiver to
MILPER Message XX-XXX paragraph (enter number).
Attached documents:
ERB (must be updated)
DA 705 (latest APFT must be within 30 days of application, score minimum 240, 80 in each event, no alternate events)
DA 4187-1-R (must be endorsed by first O5 commander or above in the CoC. RECOMMEND APPROVAL must be checked)
College transcripts (must be certified copies and show cumulative GPA, hours and degree conferred)
DA 5500/5501(if Soldier exceeds HT/WT)
DD 785 (if ineligiblility is due to non-successful completion of a commissioning course)
Last NCOER/OER, if applicable
All 1059's from training
Supporting legal documents (for civil/moral issues)
By signing, the Soldier and Commander certify that the Soldier meets all criteria as noted in the current MILPER message and AR
350-51, except as noted above.
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