DA Form 4017 "Request for Personnel Action - Nonappropriated Fund Instrumentality"

What Is DA Form 4017?

This is a military form that was released by the U.S. Department of the Army (DA) on April 1, 2010. The form, often mistakenly referred to as the DD Form 4017, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 2-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;

Download an up-to-date fillable DA Form 4017 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 4017 "Request for Personnel Action - Nonappropriated Fund Instrumentality"

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REQUEST FOR PERSONNEL ACTION - NONAPPROPRIATED FUND INSTRUMENTALITY
For use of this form, see AR 215-3; the proponent agency is DCS, G-1.
PART I - (Requesting Office will complete items A through K and 1, 13, 17a, 25, 26, and 27 as appropriate.
(If applicable, obtain resignation and separation data on reverse side.)
A. TO: Civilian Personnel Office
B. FROM:
C. REQUEST NUMBER
ATTN:
D. DATE
E. STANDARD NAFI NUMBER
F. KIND OF PERSONNEL ACTION REQUESTED (Specify Appointment, Reassignment, Promotion, Reemployment, Resignation, Change to LOWER
GRADE, Within Grade Increase, Pay Adjustment, Separation, etc.)
G. KIND OF POSITION ACTION REQUESTED
H. PROPOSED EFFECTIVE DATE
None
New
Vice
Other (Specify)
Establish
Abolish
Review
I. POSITION SENSITIVITY
Regular Full-Time
Regular Part-Time
Flexible
J. THE DESCRIPTION OF THIS POSITION IS ACCURATE
K. QUALIFICATION REQUIREMENTS
Yes
No (Attach a revised statement of duties)
Same
See attached
1. NAME (CAPS) (Last, first, MI, (Mr. or Ms.)
2. CITIZENSHIP 1 - U.S;
3. DATE OF BIRTH
2 - Non-U.S. Citizen;
(Yr, Mo, Day)
3 - Local National
6a. SCD - LEAVE
6b. SCD - LS
4. MILITARY STATUS (1 - ODM;
5. DEPENDENT STATUS (1 - Military;
2 - Retired; 3 - None)
2 - Civilian; 3 - None)
7. VETERAN'S PREFERENCE?
8. SPOUSE EMPLOYMENT PREFERENCE?
9. FAIR LABOR STANDARD ACT (FLSA)
Y - Yes
N - No
Y - Yes
N - No
(1 - Exempt; 2 - Nonexempt)
10a. CODE
10b. NATURE OF ACTION (Including Employment Category)
11. EFFECTIVE DATE
(Regular Full-Time; Regular Part-Time; Flexible)
(Yr, Mo, Day)
13. PAY PLAN
14a. GRADE
14b. STEP OR RATE
15. ANNUAL SALARY OR
12. FROM (Position Title, Number and Authorization)
AND OCC. CODE
OR PAY LEVEL
(NA; NL; NS only)
HOURLY RATE
16a. CODE, NAME, AND LOCATION OF EMPLOYING NAFI
16b. STANDARD NAFI NUMBER
18. PAY PLAN
19a. GRADE
19b. STEP OR RATE
20. ANNUAL SALARY OR
17. TO (Position Title, Number and Authorization)
AND OCC. CODE
OR PAY LEVEL
(NA; NL; NS only)
HOURLY RATE
21a. CODE, NAME, AND LOCATION OF EMPLOYING NAFI
21b. STANDARD NAFI NUMBER
22. DUTY STATION
23. LOCATION CODE
24. REMARKS
25. SIGNATURE, DATE, AND TITLE OF REQUESTING OFFICIAL
26. SIGNATURE, DATE, AND TITLE OF APPROVING OFFICIAL
DA FORM 4017, APR 2010
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
REQUEST FOR PERSONNEL ACTION - NONAPPROPRIATED FUND INSTRUMENTALITY
For use of this form, see AR 215-3; the proponent agency is DCS, G-1.
PART I - (Requesting Office will complete items A through K and 1, 13, 17a, 25, 26, and 27 as appropriate.
(If applicable, obtain resignation and separation data on reverse side.)
A. TO: Civilian Personnel Office
B. FROM:
C. REQUEST NUMBER
ATTN:
D. DATE
E. STANDARD NAFI NUMBER
F. KIND OF PERSONNEL ACTION REQUESTED (Specify Appointment, Reassignment, Promotion, Reemployment, Resignation, Change to LOWER
GRADE, Within Grade Increase, Pay Adjustment, Separation, etc.)
G. KIND OF POSITION ACTION REQUESTED
H. PROPOSED EFFECTIVE DATE
None
New
Vice
Other (Specify)
Establish
Abolish
Review
I. POSITION SENSITIVITY
Regular Full-Time
Regular Part-Time
Flexible
J. THE DESCRIPTION OF THIS POSITION IS ACCURATE
K. QUALIFICATION REQUIREMENTS
Yes
No (Attach a revised statement of duties)
Same
See attached
1. NAME (CAPS) (Last, first, MI, (Mr. or Ms.)
2. CITIZENSHIP 1 - U.S;
3. DATE OF BIRTH
2 - Non-U.S. Citizen;
(Yr, Mo, Day)
3 - Local National
6a. SCD - LEAVE
6b. SCD - LS
4. MILITARY STATUS (1 - ODM;
5. DEPENDENT STATUS (1 - Military;
2 - Retired; 3 - None)
2 - Civilian; 3 - None)
7. VETERAN'S PREFERENCE?
8. SPOUSE EMPLOYMENT PREFERENCE?
9. FAIR LABOR STANDARD ACT (FLSA)
Y - Yes
N - No
Y - Yes
N - No
(1 - Exempt; 2 - Nonexempt)
10a. CODE
10b. NATURE OF ACTION (Including Employment Category)
11. EFFECTIVE DATE
(Regular Full-Time; Regular Part-Time; Flexible)
(Yr, Mo, Day)
13. PAY PLAN
14a. GRADE
14b. STEP OR RATE
15. ANNUAL SALARY OR
12. FROM (Position Title, Number and Authorization)
AND OCC. CODE
OR PAY LEVEL
(NA; NL; NS only)
HOURLY RATE
16a. CODE, NAME, AND LOCATION OF EMPLOYING NAFI
16b. STANDARD NAFI NUMBER
18. PAY PLAN
19a. GRADE
19b. STEP OR RATE
20. ANNUAL SALARY OR
17. TO (Position Title, Number and Authorization)
AND OCC. CODE
OR PAY LEVEL
(NA; NL; NS only)
HOURLY RATE
21a. CODE, NAME, AND LOCATION OF EMPLOYING NAFI
21b. STANDARD NAFI NUMBER
22. DUTY STATION
23. LOCATION CODE
24. REMARKS
25. SIGNATURE, DATE, AND TITLE OF REQUESTING OFFICIAL
26. SIGNATURE, DATE, AND TITLE OF APPROVING OFFICIAL
DA FORM 4017, APR 2010
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
27. REMARKS (Continued)
PART II - (Employee will complete items 29 through 33)
28. RESIGNATION (To be completed, when possible, by an employee who resigns. Give specific reasons for your resignation, e.g., to move to
another city. Avoid general reasons such as "ill health" or "personal reasons.")
I VOLUNTARILY RESIGN MY POSITION FOR THE FOLLOWING REASON(s):
30. FORWARDING ADDRESS (For mailing communications, paycheck, bonds, etc.)
29. LAST DATE OF DUTY
31. SIGNATURE OF EMPLOYEE
33. DATE SIGNED
REVERSE, DA FORM 4017, APR 2010
APD LC v1.00ES
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