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
Page 1 of 2
Commander, AHRC
SFAB Branch Manager
1600 Spearhead Division Ave
Fort Knox, KY 40122
Soldier O5 Level Command
Address
1. Security Force Assistance Brigade (SFAB) Selection Criteria:
a. Is the Soldier AR 600-9 compliant? Y/N
b. Is the Soldier fully deployable minimum PULHES of 111221 (no APFT or deployment limiting profile).? Y/N
c. Does the Soldier pass the APFT with a minimum score of 240 (at least 70 in each event)? Y/N
d. Does the Soldier have a valid security clearance (Secret or higher)? Y/N; Level
e. Is the Soldier's service record clear of any disciplinary issues or derogatory information within the last 3 years? Y/N Remarks
f. Does the Soldier's manner of performance reflect a high performance with strong potential? Y/N Remarks
g. Is the Soldier Key and Developmental complete (Officers/NCOs only)? Y/N Position
h. Does the Soldier have prior successful command team (Brigade/Battalion/Company) service (SFC and above)? Y/N level
2. Soldier understands that they are required to meet the SRR for the assignment to the SFAB prior to being screened by their PCM.
3. Soldier is prepared to attend the SFAB assessment at the scheduled assessment time to be coordinated with the SFAB team.
a. Soldier email address: XXX@mail.mil Soldier contact number: XXX-XXX-XXXX
b. BN CDR/CSM e-mail: XXX@mail.mil BN CDR/CSM contact number: XXX-XXX-XXXX
4. Soldier acknowledges by her/his signature in BLOCK 9 that s/he understands they are volunteering for 36 Months of SFAB duty.
5. If selected, they will proceed immediately for expeditious assignment instructions to report NLT date determined by SFAB
leadership.
6. If selected, SM agrees to waive reenlistment commitment, if applicable, for assignment to SFAB. Y/N
7. Soldier's top three location preferences are: a) Fort XXXX b) Fort XXXX c) Fort XXXX
SFAB ASSESSMENT/
ASSIGNMENT
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