Ar-medcom Form 16-r (commander's Statement)

COMMANDER'S STATEMENT ______________________________________ (SOLDIERS NAME) a. Current Height/Weight: _______________ b. Maximum allowable weight/body fat percentage IAW AR 600-9: __________________________ c. If over maximum table weight, body fat percentage: __________________________ (DA Form 5500/5501 within last 6 months) d. Date of the last physical examination: __________________________ e. PULHES and Category Code shown on last physical exam: P ______ U ______ L ______ H ______ E ______ S ______ Category Code: ___________ f. Current Physical limitations/Permanent Profiles/Temporary Profiles: DA Form 3349)

(Attach

_________________________________________________________________________________________ _________________________________________________________________________________________ g. Physically qualified to perform in recommended MOS ________ (YES/NO) h. Verification of Security Clearance if applicable: DATE

TYPE

LEVEL

i. Deployment Information if applicable: DATE:

REFRAD:

OPERATION:

j. Remarks: ___________________________________________________________________________ ______________________________________________________________________________________ I, the undersigned, certify that the above information is true and correct: Date: __________________

_____________________________________ (Commander's Signature) CLIFFORD D. GERHKE MAJ, MS Commanding

ARMEDCOM FORM 16-R 1 OCT 05