REENLISTMENT REQUEST/INFORMATION SHEET

 

 

Rate SSN Command UIC

Home of Record State

Eligible/Not Eligible to reenlist

(PRT Coordinator)

Physically qualified to reenlist or extend

(Medical Department Representative) (Date)

Member is within one year of EAOS EAOS

(Command Career Counselor) (YYMMDD)

Recommendation:

Approve / Disapprove

(LPO)

Approve / Disapprove

(Division Officer)

Approve / Disapprove

(Department Chief)

Approve / Disapprove

(Department Head)

Approve / Disapprove

(COB)

Approve / Disapprove

(Executive Officer)

Final Disposition:

Approve / Disapprove

(Commanding Officer)

 

    1. Name of spouse: .
    2. Location of ceremony: , time: .
    3. Hometown news release on file ( yes / no ): .

      4. (Public Affairs Officer)

    4. Photographic request completed on by .

      5. (Date) (CCC/PAO)

    5. Base paper article prepared on by .

(Date) (CCC/PAO)

 

 

 

PSD BANGOR 1160/2 (REV 10/99) OVER

    1. Member is reenlisting under program.

      2. ( SCORE / STAR / SRB / BOR )

    2. SRB eligible ( YES / NO ) , CREO group , SRB multiple of .
    3. ADSD , PEBD , EAOS .
    4. Additional service months .
    5. Member should receive a total bonus of approximately . The first installment of about and additional installments of approximately .
    6. Member desires to sell days leave.

 

Type of Reenlistment ( 1AA / 1BB / 1CC / 1EE / 1RR ) NEC

CONSUBPAY / NUC EXT (Months, 00 if none):

Other INOP EXT: Current EAOS

SEP Paygrade: (actual paid status, not frocked grade)

CO Comments:

 

ENCORE/STAR/CONVERSION CERTIFICATION

SSN: NAME:

FORMAN PROGRAM:

REQUESTING UIC: DTG:

PNA: CO RECOM ADV: SRB:

OBLISERV: ORDERS NUM: TERM REENL:

STAR/C SCH REQ: SCHOOL:

CANC REQ: REASON: ERROR REENL:

VOL SEP:

GOOD CONDUCT: PRT:

SUBSTANCE ABUSE CODE: DATES: MISCONDUCT HISTORY: DATES:

USNR: USN: MARINER: TAR:

USN TO TAR: TAR TO USN: CONVERSION:

DATE:

EVAL 1: (YY/MM) (GRADES)

EVAL 1: (YY/MM) (GRADES)

EVAL 1: (YY/MM) (GRADES)

CO COMMENTS: (4 LINES MAX)