DA Form 3887 Nursing Department - Army Nurse Corps Data

DA Form 3887 - also known as the "Nursing Department - Army Nurse Corps Data" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 3887 - was last revised on April 1, 2010. Download an up-to-date fillable PDF version of the DA 3887 below or request a copy through the chain of command.

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NAME (Last, First, Middle Initial)
TEMP GRADE & DATE
PERM GRADE & DATE
(Check one)
RA
USAR
DATE OF BIRTH
RELIGION
SERVICE AGREEMENT
EXPIRATION DATE
DATE CURRENT
PMOS
SMOS
DMOS
TOUR AD
MARITAL STATUS
MAIDEN NAME
WIFE OR HUSBAND'S NAME
(Check one)
SINGLE
MARRIED
OTHER
(Include Zip Code)
LOCAL ADDRESS
TELEPHONE NUMBER
SECURITY CLEARANCE
NEXT OF KIN INFORMATION
NAME AND RELATIONSHIP
ADDRESS
TELEPHONE NUMBER
(Include Zip Code)
(Include Area Code)
SCHOOL OF NURSING INFORMATION
NAME OF SCHOOL
MAJOR FIELD
STATE
YEAR
DIPLOMA
DEGREE-YEAR
CURRENT REGISTRATION
DATE RETURNED FROM OVERSEAS
STATE AND YEAR
REGISTRATION NUMBER
EXPIRATION DATE
PROFESSIONAL ORGANIZATION MEMBERSHIPS
(Check applicable box(es))
OTHER
AMERICAN NURSES ASSOCIATION
NATIONAL LEAGUE FOR NURSING
(Specify)
NURSING ASSIGNMENT PREFERENCE
FIRST
SECOND
THIRD
ASSIGNED
DATE
PREVIOUS EDITIONS
NURSING DEPARTMENT - ARMY NURSE CORPS DATA
DA FORM 3887 APR 2010
ARE OBSOLETE
For use of this form, see AR 40-3; the proponent agency is
Office of The Surgeon General
DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a)
1. AUTHORITY: 5 US Code 301, Departmental Regulations. 10 US Code 1071, Medical & Dental Care Purposes.
42 US Code, Social Security. 44 US Code 3101, Record Management by Agencies, General Duties.
2. PRINCIPAL PURPOSE(S): This form is to provide a ready source of professional and personal information on
each Army Nurse Corps officer in the Office of the Chief, Department of Nursing. During inprocessing to a medical
treatment facility, individual officers complete this data card and report necessary changes as these occur.
3. ROUTINE USES: The DoD 'Blanket Routine Uses' set forth at the beginning of the Army's compilation of systems
of records notices also apply to this system.
4. MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING
INFORMATION: Voluntary; however, failure to provide the requested information may result in the improper utilization/
assignment of Army Nurse Corps officer and safe, effective nursing care to patients.
NAME (Last, First, Middle Initial)
TEMP GRADE & DATE
PERM GRADE & DATE
(Check one)
RA
USAR
DATE OF BIRTH
RELIGION
SERVICE AGREEMENT
EXPIRATION DATE
DATE CURRENT
PMOS
SMOS
DMOS
TOUR AD
MARITAL STATUS
MAIDEN NAME
WIFE OR HUSBAND'S NAME
(Check one)
SINGLE
MARRIED
OTHER
(Include Zip Code)
LOCAL ADDRESS
TELEPHONE NUMBER
SECURITY CLEARANCE
NEXT OF KIN INFORMATION
NAME AND RELATIONSHIP
ADDRESS
TELEPHONE NUMBER
(Include Zip Code)
(Include Area Code)
SCHOOL OF NURSING INFORMATION
NAME OF SCHOOL
MAJOR FIELD
STATE
YEAR
DIPLOMA
DEGREE-YEAR
CURRENT REGISTRATION
DATE RETURNED FROM OVERSEAS
STATE AND YEAR
REGISTRATION NUMBER
EXPIRATION DATE
PROFESSIONAL ORGANIZATION MEMBERSHIPS
(Check applicable box(es))
OTHER
AMERICAN NURSES ASSOCIATION
NATIONAL LEAGUE FOR NURSING
(Specify)
NURSING ASSIGNMENT PREFERENCE
FIRST
SECOND
THIRD
ASSIGNED
DATE
PREVIOUS EDITIONS
NURSING DEPARTMENT - ARMY NURSE CORPS DATA
DA FORM 3887 APR 2010
ARE OBSOLETE
For use of this form, see AR 40-3; the proponent agency is
Office of The Surgeon General
DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a)
1. AUTHORITY: 5 US Code 301, Departmental Regulations. 10 US Code 1071, Medical & Dental Care Purposes.
42 US Code, Social Security. 44 US Code 3101, Record Management by Agencies, General Duties.
2. PRINCIPAL PURPOSE(S): This form is to provide a ready source of professional and personal information on
each Army Nurse Corps officer in the Office of the Chief, Department of Nursing. During inprocessing to a medical
treatment facility, individual officers complete this data card and report necessary changes as these occur.
3. ROUTINE USES: The DoD 'Blanket Routine Uses' set forth at the beginning of the Army's compilation of systems
of records notices also apply to this system.
4. MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING
INFORMATION: Voluntary; however, failure to provide the requested information may result in the improper utilization/
assignment of Army Nurse Corps officer and safe, effective nursing care to patients.
NURSING EDUCATION AND EXPERIENCE
POST GRADUATE AND UNIVERSITY COURSES
COURSE
INSTITUTION
LOCATION
INCLUSIVE DATES
MILITARY COURSES
CIVILIAN NURSING EXPERIENCE
CLINICAL FIELD
POSITION
LOCATION
INCLUSIVE DATES
MILITARY NURSING EXPERIENCE
REMARKS
(Check one)
NAME (Last, First, Middle Initial)
DMOS
FORM COMPLETED
(Date)
RA
USAR
REVERSE OF DA FORM 3887, APR 2010
APD LC v1.00

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