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CHECKLIST FOR SGT/SSG PROMOTION SELECTION BOARD Privacy Act Notification Statement For Enlisted Promotion Packets For uses of this form see AR-MEDCOM Promotion Packets Instructions; the proponent agency is DCSPER Authority:

Executive Order 9397 authorizes DA to use SSN as a system to identify Army members

Principal Purposes: To provide DCSPER with a soldier- unique tracking number for use with database and filing system Routine Use:

Information is releasable to order agencies of federal, state and local government as prescribed in AR 340-21, paragraph 3-1 and 3-2. Information will not be released to the public without prior consent. This form will be signed by soldier and accompany the promotion packet

Disclosure:

Disclosure of information is voluntary. Failure to disclose information may result in this request not being processed. ________________________________________________________________________________________________________________________

NOTE: THIS DOCUMENT MUST BE INCLUDED AS THE COVER SHEET FOR THE PROMOTION SELECTION PACKET UNIT: AR-MEDCOM

UIC: W858AA

UNIT POC:

DRC:

MSC:

RRC:

UNIT PHONE & FAX:

NAME (LAST, FIRST, MI) SOLDIERS ADDRESS

SSN: CITY

STATE:

CURRENT GRADE: ZIP+4 CODE:

The specific items and forms listed below will be checked in the space provided to ensure that all documents required by this recommendation for promotion have been supplied and/or properly completed IAW AR 140-158. ( ) 1. Tab A through J completed. Documents with data on the reverse side will be photographed wither as two separate pages or as a two-sided, head-to-foot copy. All documents must be current as of the convening date of the board. ( ) Tab A: DA 3355, May 2000, (Must enter remarks per AR 600-8-19, para 3-10b (1), (2), & (3). ( ) Tab B: Current of copy of DA Form 2A and DA Form 2-1 (ALL pages) Certified true and correct copy of original by records custodian. Weapons qualifications (junior enlisted only) ( ) Tab C: Copy of DD Forms 214/215, or NGB 22, current deployment/mobilization orders, as applicable. ( ) Tab D: Highest level of civilian education obtained (High school diploma, GED minimum or College Transcripts or Diploma). ( ) Tab E: Most recent DA Form 705 (for record within 12 months or less), and if applicable, current DA Form 5500-R/5501-R or DA Form 3349. ( ) Tab F: Current promotion order or documentation of MOS(s) awarded. Required current professional license for MOS. Security Clearance or Interim Clearance. (Only if required by MOS). ( ) Tab G: Academic Reports for all military courses (DA Form 1059, Certificate of Training or DD 214. Place NCOES with highest level on top. (N/A) Tab H: Copies of last five rated years of NCOERs (both pages, copied head-to-foot, or as separate pages) and/or signed statement from current unit commander explaining missing reports. Most current on top.

ARMEDCOM FORM 14-R 4 APR 08

( ) Tab I: Military awards/decorations (orders or certificates), letters and/or certificates of commendation, appreciation, achievement. ( ) Tab J: Commander’s Statement (AR-MEDCOM Form 16-R) ( ) 2. The following data pertaining to this soldier has been verified. ( ) Soldier is an Army Reserve Technician (ART)

_________________________ Date of initial employment

( ) AMSA or ECS employee

_________________________ Date of initial employment ( ) 3. I will accept a position within _______miles from my residence _______________________________ (city, state) All soldiers may be assigned within a 50-mile commuting distance, not to exceed 90-minute travel time. SPECIAL SKILL IDENTIFIER/REQUIREMENTS POSITION CONSIDERATION (

) 4. I wish to be considered for promotion in the following types of positions. (Soldier initials Yes or No) YES NO Airborne - DMOS with SQI "P". Drill Sergeant - DMOS with SQI "X" First Sergeant - DMOS with SQI "M" Instructor - DMOS with SQI "H" Observer/Controller - DMOS identified as an "O/C" position

If not already awarded the Skill Qualification Identifier (P, X, M, or H) or not having completed the Observer/Controller Course, I understand that I must enroll in and successfully complete the required course. I am fully aware and understand that, if promoted and assigned to an Airborne, Drill Sergeant, First Sergeant, Instructor or Observer/Controller position, failure or refusal to complete the required training may be grounds for involuntary reassignment. SOLDIER/UNIT COMMANDER'S VERIFICATION: I have reviewed the entire promotion packet. I certify that to the best of my knowledge, the contents of the packet are accurate and complete.

______________________________________________ Signature of Soldier ONLY Date signed:

_____________________________________ Signature of Commander (or designee) Date: ______________________________________ (TYPED SIGNATURE BLOCK) , USAR Commanding

ARMEDCOM FORM 14-R 4 APR 08