Fillable RECORD OF ENLISTED COUNSELING

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RECORD OF ENLISTED COUNSELING

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The RECORD OF ENLISTED COUNSELING form is 2 pages long and contains:

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DATE
RECORD OF ENLISTED COUNSELING
PRIVACY ACT STATEMENT
The authority for requesting the following information is contained in 5 U.S.C.
sec. 301, 10 U.S.C. 5947, 44 U.S.C. sec. 3101, and Executive Order No. 9397.
This information will be used to document quality force counseling actions not
prescribed in other directives. Department of the Navy personnel may also use
the information for evaluations and determinations in disciplinary, punitive
and/or administrative actions. Disclosure of this information is voluntary.
GRADE
SSN
NAME (Last, First, Middle Initial)
NAME/GRADE OF COUNSELOR
DIVISION/WORK CENTER/DUTY SECTION
REASON FOR COUNSELING
PERFORMANCE RESPONSIBILITIES
OJT PROGRESS CAREER ADVANCEMENT
SUBSTANDARD APPEARANCE PERSONAL BEHAVIOR
SUPPORT OF DEPENDENTS PRIVATE INDEBTEDNESS
OTHER (Specify)
REASONS WHICH CAUSED THE COUNSELING REQUIREMENT
(Give facts, details, sequence of events, specific dates, etc.)
-
-
NSN 0106-LF-010-1000
NAVPERS 1616/25 (5-90)
PLAN (DEVELOPED BY THE MEMBER AND COUNSELOR) TO CONTINUE SUPERIOR PERFORMANCE OR
TO OVERCOME PROBLEM(S) AND PRECLUDE FUTURE INVOLVEMENT
(Outline all resolutions discussed and indicate which actions the member has personally elected to pursue.)
-
Signature of Member/Date
Signature of Counselor/Date
I do/do not desire to make a statement.
Signature of Member/Date
NAVPERS 1616/25 (5-90)
• U.S. GPO: 19W-704-119/20152
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RECORD OF ENLISTED COUNSELING

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Completed 13 March 2022

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