DA Form 4162 Volunteer Service Record

DA Form 4162 - also known as the "Volunteer Service Record" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 4162 - was last revised on July 1, 2003. Download an up-to-date fillable PDF version of the DA 4162 down below or look it up on the Army Publishing Directorate website.

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VOLUNTEER SERVICE RECORD
For use of this form, see AR 608-1; the proponent agency is OACSIM.
PRIVACY ACT STATEMENT
AUTHORITY:
5 USC Section 301, Department Regulations; 10 USC Section 3013, Secretary of the Army; and Army Regulation
608-1, Army Community Service Center.
PRINCIPAL PURPOSE:
To record essential background information on volunteers to assist in determining qualifications and task
assignments. To maintain record of positions held, hours volunteered, training and awards received.
ROUTINE USES:
None. The "Blanket Routine Uses" set forth at the beginning of the Army's Complications of System of Records
Notices apply to this system.
DISCLOSURE:
Voluntary. However, failure to provide the requested information may exclude you from participating in the Army
Community Service Volunteer Program.
INSTRUCTIONS: Upon resignation, retirement or transfer, the original of this record will be furnished for the personal file of the volunteer and a duplicate
will be maintained at the organization for at least three years. In case of transfer, a duplicate record will be furnished to the gaining organization upon
request of the volunteer.
1. NAME OF VOLUNTEER (Last, First, MI)
2. HOME ADDRESS (Street, City, State and ZIP Code)
3. EMAIL ADDRESS
4. TELEPHONE NUMBERS
5. SEX
MALE
FEMALE
a. HOME
b. WORK
6. DATE OF BIRTH (YYYYMMDD)
c. FAX
7a. SPONSOR NAME
7b. SPONSOR UNIT ADDRESS
8. Mark all the demographic data that applies to the volunteer. Family members of service members should indicate the branch of service and status of
the sponsor.
SERVICE MEMBER
ARMY
AIR FORCE
NAVY
MARINE
CIVILIAN EMPLOYEE
OFFICER
ENLISTED
(APF and NAF)
ADULT FAMILY MEMBER
ACTIVE DUTY
RETIRED
YOUTH FAMILY MEMBER
RESERVE
GUARD
(Under age 18 and unmarried)
CIVILIAN (Not connected with
DECEASED
the military)
9. CHILDREN AT HOME
10. INITIAL COMMITMENT
NONE
PRESCHOOL
IN SCHOOL
ONE DAY EVENT
ONE MONTH EVENT
THREE MONTHS
11. EDUCATION
ADVANCED
HIGH SCHOOL
COLLEGE
SIX MONTHS
NINE MONTHS
OTHER
DEGREE
12. WORK EXPERIENCE
13. VOLUNTEER EXPERIENCE
DA FORM 4162, MAY 1999, IS OBSOLETE.
Page 1 of 2
DA FORM 4162, JUL 2003
APD LC v1.01ES
VOLUNTEER SERVICE RECORD
For use of this form, see AR 608-1; the proponent agency is OACSIM.
PRIVACY ACT STATEMENT
AUTHORITY:
5 USC Section 301, Department Regulations; 10 USC Section 3013, Secretary of the Army; and Army Regulation
608-1, Army Community Service Center.
PRINCIPAL PURPOSE:
To record essential background information on volunteers to assist in determining qualifications and task
assignments. To maintain record of positions held, hours volunteered, training and awards received.
ROUTINE USES:
None. The "Blanket Routine Uses" set forth at the beginning of the Army's Complications of System of Records
Notices apply to this system.
DISCLOSURE:
Voluntary. However, failure to provide the requested information may exclude you from participating in the Army
Community Service Volunteer Program.
INSTRUCTIONS: Upon resignation, retirement or transfer, the original of this record will be furnished for the personal file of the volunteer and a duplicate
will be maintained at the organization for at least three years. In case of transfer, a duplicate record will be furnished to the gaining organization upon
request of the volunteer.
1. NAME OF VOLUNTEER (Last, First, MI)
2. HOME ADDRESS (Street, City, State and ZIP Code)
3. EMAIL ADDRESS
4. TELEPHONE NUMBERS
5. SEX
MALE
FEMALE
a. HOME
b. WORK
6. DATE OF BIRTH (YYYYMMDD)
c. FAX
7a. SPONSOR NAME
7b. SPONSOR UNIT ADDRESS
8. Mark all the demographic data that applies to the volunteer. Family members of service members should indicate the branch of service and status of
the sponsor.
SERVICE MEMBER
ARMY
AIR FORCE
NAVY
MARINE
CIVILIAN EMPLOYEE
OFFICER
ENLISTED
(APF and NAF)
ADULT FAMILY MEMBER
ACTIVE DUTY
RETIRED
YOUTH FAMILY MEMBER
RESERVE
GUARD
(Under age 18 and unmarried)
CIVILIAN (Not connected with
DECEASED
the military)
9. CHILDREN AT HOME
10. INITIAL COMMITMENT
NONE
PRESCHOOL
IN SCHOOL
ONE DAY EVENT
ONE MONTH EVENT
THREE MONTHS
11. EDUCATION
ADVANCED
HIGH SCHOOL
COLLEGE
SIX MONTHS
NINE MONTHS
OTHER
DEGREE
12. WORK EXPERIENCE
13. VOLUNTEER EXPERIENCE
DA FORM 4162, MAY 1999, IS OBSOLETE.
Page 1 of 2
DA FORM 4162, JUL 2003
APD LC v1.01ES
14. SPECIAL SKILLS, INTEREST, HOBBIES
15. POSITIONS HELD
START DATE
END DATE
TYPE OF POSITION
(YYYYMMDD)
(YYYYMMDD)
16. AWARDS AND SPECIAL RECOGNITION
DATE
TYPE OF AWARD/SPECIAL RECOGNITION
PRESENTED AT
(YYYYMMDD)
17. TRAINING
DATE
HOURS
TYPE OF TRAINING
(YYYYMMDD)
COMPLETED
18. VOLUNTEER ANNUAL HOUR RECORD
YEAR
HOURS
19a. SIGNATURE
19b. DATE (YYYYMMDD)
DA FORM 4162, JUL 2003
Page 2 of 2
APD LC v1.01ES

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