DA Form 1058 Application for Active Duty for Training, Active Duty for Operational Support, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve

What Is DA Form 1058?

DA Form 1058 or the Application for Active Duty for Training, Active Duty for Special Work, Temporary Tour of Active Duty, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve is a form issued by the Department of the Army (DA). An up-to-date DA 1058 fillable form can be downloaded below.

The form is used for determining eligibility for Active Duty and scheduling Army National Guard and U.S. Army Reserve soldiers for Special Work, Temporary Tours, and Annual Training on requested dates. The application - often incorrectly referred to as the DD Form 1058 or DA Form 1058-R - was last revised in September 2017 with all previous editions obsolete.

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APPLICATION FOR ACTIVE DUTY FOR TRAINING, ACTIVE DUTY FOR OPERATIONAL SUPPORT, AND
ANNUAL TRAINING FOR SOLDIERS OF THE ARMY NATIONAL GUARD AND U.S. ARMY RESERVE
For use of this form, see AR 135-200; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
10 USC 672(d) and USC 275.
To determine eligibility and schedule individuals for active duty for operational support or active duty for training
PRINCIPAL PURPOSE:
on requested dates.
To identify the applicant as a Reserve Component member and to issue active duty for operational support or
ROUTINE USES:
active duty for training orders.
Completing this form is mandatory for individuals applying for active duty for operational support and active duty
DISCLOSURE:
for training. If not completed, you will be ineligible for the requested tour.
PART I - APPLICANT (Read instructions in AR 135-200 before completing this form.)
1. TO (Include ZIP Code)
2a. NAME (Last, First, MI)
2b. RESERVE COMPONENT CATEGORY
IMA
IRR
TPU
ARNG
ARNGUS
4a. ADDRESS FROM WHICH YOU WILL REPORT FOR DUTY (If
3a. PERMANENT HOME ADDRESS (Include ZIP Code)
different from permanent home address) (Include ZIP Code)
3b. PRIMARY TELEPHONE NUMBER (Include area code)
4b. PRIMARY TELEPHONE NUMBER (Include area code)
3c. SECONDARY TELEPHONE NUMBER (Include area code)
4c. SECONDARY TELEPHONE NUMBER (Include area code)
5. UNIT OF ASSIGNMENT OR ATTACHMENT AND UIC
6. GRADE
7. BRANCH
8. GENDER
9. DOB
10. MARITAL STATUS
11. NO. OF DEPENDENTS
Male
Female
12. PRIMARY SSI (AOC) /MOS
13. DUTY SSI (AOC) /MOS
14. APFT DATE
Go
15. HT/WT
Go
No Go
No Go
17. TOTAL YEARS, MONTHS, DAYS OF
16.
ACTIVE FEDERAL SERVICE (AFS)
drawing a pension, disability compensation,
I am
I am not
or retired pay from the U.S. Government.
18. FOR INDIVIDUAL MOBILIZATION AUGMENTEES ONLY: THIS APPLICATION IS FOR (Check one)
IMA AT
IMA AT w/IDT
ADT in lieu of IMA AT
Additional ADT
19. DATES OF ADOS/TTAD/ADT/AT REQUESTED
a. FIRST CHOICE
b. SECOND CHOICE
NUMBER OF DAYS
BEGINNING DATE/TIME
NUMBER OF DAYS
REPORT DATE
LOCATION (Include Zip Code)
LOCATION (Include Zip Code)
DUTY/TRAINING AGENCY AND UIC
DUTY/TRAINING AGENCY AND UIC
20. REMARKS
I understand that although at the completion of my tour I may be within 2 years of qualifying for an active duty retirement under 10 USC 1293, 3911, or
3914, it is current Army policy that I will be released from active duty at the completion of my tour unless continued retention on active duty is
considered in the best interest of the Army by the Assistant Secretary of the Army (Manpower and Reserve Affairs). I hereby consent to my release
from active duty at the completion of this tour.
(Signature of applicant)
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
DA FORM 1058, SEP 2017
APPLICATION FOR ACTIVE DUTY FOR TRAINING, ACTIVE DUTY FOR OPERATIONAL SUPPORT, AND
ANNUAL TRAINING FOR SOLDIERS OF THE ARMY NATIONAL GUARD AND U.S. ARMY RESERVE
For use of this form, see AR 135-200; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
10 USC 672(d) and USC 275.
To determine eligibility and schedule individuals for active duty for operational support or active duty for training
PRINCIPAL PURPOSE:
on requested dates.
To identify the applicant as a Reserve Component member and to issue active duty for operational support or
ROUTINE USES:
active duty for training orders.
Completing this form is mandatory for individuals applying for active duty for operational support and active duty
DISCLOSURE:
for training. If not completed, you will be ineligible for the requested tour.
PART I - APPLICANT (Read instructions in AR 135-200 before completing this form.)
1. TO (Include ZIP Code)
2a. NAME (Last, First, MI)
2b. RESERVE COMPONENT CATEGORY
IMA
IRR
TPU
ARNG
ARNGUS
4a. ADDRESS FROM WHICH YOU WILL REPORT FOR DUTY (If
3a. PERMANENT HOME ADDRESS (Include ZIP Code)
different from permanent home address) (Include ZIP Code)
3b. PRIMARY TELEPHONE NUMBER (Include area code)
4b. PRIMARY TELEPHONE NUMBER (Include area code)
3c. SECONDARY TELEPHONE NUMBER (Include area code)
4c. SECONDARY TELEPHONE NUMBER (Include area code)
5. UNIT OF ASSIGNMENT OR ATTACHMENT AND UIC
6. GRADE
7. BRANCH
8. GENDER
9. DOB
10. MARITAL STATUS
11. NO. OF DEPENDENTS
Male
Female
12. PRIMARY SSI (AOC) /MOS
13. DUTY SSI (AOC) /MOS
14. APFT DATE
Go
15. HT/WT
Go
No Go
No Go
17. TOTAL YEARS, MONTHS, DAYS OF
16.
ACTIVE FEDERAL SERVICE (AFS)
drawing a pension, disability compensation,
I am
I am not
or retired pay from the U.S. Government.
18. FOR INDIVIDUAL MOBILIZATION AUGMENTEES ONLY: THIS APPLICATION IS FOR (Check one)
IMA AT
IMA AT w/IDT
ADT in lieu of IMA AT
Additional ADT
19. DATES OF ADOS/TTAD/ADT/AT REQUESTED
a. FIRST CHOICE
b. SECOND CHOICE
NUMBER OF DAYS
BEGINNING DATE/TIME
NUMBER OF DAYS
REPORT DATE
LOCATION (Include Zip Code)
LOCATION (Include Zip Code)
DUTY/TRAINING AGENCY AND UIC
DUTY/TRAINING AGENCY AND UIC
20. REMARKS
I understand that although at the completion of my tour I may be within 2 years of qualifying for an active duty retirement under 10 USC 1293, 3911, or
3914, it is current Army policy that I will be released from active duty at the completion of my tour unless continued retention on active duty is
considered in the best interest of the Army by the Assistant Secretary of the Army (Manpower and Reserve Affairs). I hereby consent to my release
from active duty at the completion of this tour.
(Signature of applicant)
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
DA FORM 1058, SEP 2017
PART II - RECORDS CUSTODIAN
23. PROMOTION
21. PAY ENTRY BASIC DATE
22. SECURITY CLEARANCE
24. DATE OF RANK
CONSIDERATION CODE
27. MANDATORY REMOVAL
25. RYE DATE
28. PHA DATE
26. ETS (Enlisted)
DATE (Officers)
29. HIV TEST DATE
30. PANOGRAPHIC DENTAL X-RAY ON FILE
YES
NO
31. REMARKS
32a. NAME, RANK, PHONE AND EMAIL OF UNIT COMMANDER
c. DATE
b. SIGNATURE OF UNIT COMMANDER
33a. NAME, RANK, PHONE AND EMAIL OF RECORDS CUSTODIAN
b. SIGNATURE
c. DATE
REVERSE, DA FORM 1058, SEP 2017
APD LC v1.00ES

Download DA Form 1058 Application for Active Duty for Training, Active Duty for Operational Support, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve

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DA Form 1058 Instructions

The DA 1058 itself consists of two sections or parts: Part I is for the applicant and must be signed by the soldier themselves. Unit representatives are strictly forbidden to sign the form for the soldier. Part II is filed by the records custodian.

  1. Boxes 1 through 4 identify the soldier, provide their home address, home and business telephone numbers and the address from which the soldier will report for duty. The last part is filed by soldiers whose HOR is outside the commuting distance of their duty location.
  2. Enter the unit of assignments, grade, and branch in Boxes 5, 6 and 7, respectively.
  3. Boxes 8 to 17 describe the applicant's sex, height, weight, date of birth, marital status, primary SSI, duty SSI and total time spent in active federal service.
  4. Box 18 is filed by individual mobilization augmentees only.
  5. Box 19 lists dates and location of ADSW/TTAD/ADT/AT requested.
  6. Box 20 assesses medical fitness The soldier must list the date of their last PHA/Exam in Box 20a and its location in Box 20b.
  7. The soldier must sign and date the form in Boxes 21 and 22.
  8. The soldier then signs Box 23, Remarks, consenting to their release from active duty at the completion of the tour they are applying to.
  9. Boxes 24 through 33 are filled by the records custodian.
  10. You are not supposed to fill out Box 34 if it is not showing on your ORDERS QUERY printout. If everything is correct, put SEE ORDERS QUERY in the first line of Box 34a. Not all Title 10 tours show on ORDERS QUERY - must put those down below if you do not have a state order covering that order.
  11. The custodian then signs the form in Box 35 verifying that the information on the DA 1058-R is accurate and that the soldier meets the medical requirements for tour consideration in NGB PPOM 13-020 para 14.

Additional instructions and filing guidelines can be found in the AR 135-200 (Active Duty for Missions, Projects, and Training for Reserve Component Soldiers) released in September 2017.

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