How to Fill Out DA Form 4126?
An overview of the bar to continued service form and filing guidelines can be found in the Army Regulation 601-280, Army Retention Program, released in April 2016. DA Form 4126 instructions are as follows:
- Section I contains the commander's recommendation. First, the commander has to provide the name of the barred soldier, the name of the next higher CDR and the name of initiating CDR - their own. The form then requires the full name of the soldier once again along with their rank, DEROS and ETS, the date of bar initiation and the total active federal service dates. The reasons for the bar (Item 10) must be proven with attached supporting documents.
- Section II - Soldier's Review - is filled in by the barred service member. They must confirm that all presented allegations are truthful. If the soldier disagrees, they can submit a statement on their own behalf in accordance with the AR 600-37. The soldier receives a copy of the form with a 7-day period to prepare their comments and collect papers to support their statements. An extension of the period can be granted if the initiating commander believes it to be necessary. If the Soldier showed no desire to make a statement, the bar will be processed immediately.
- Section III is filed by the next higher command. After they review the bar, they must provide their approval or disapproval it in this section.
- Section IV is for the information on counseling by the initiating commander. This section confirms the approval or disapproval of the DA 4126 and whether the soldier will appeal the bar or not. This section requires the initiating commander's and the soldiers' full names, ranks, signatures, and dates of filing.
1
2BAR TO CONTINUED SERVICE
For use of this form, see AR 601-280; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AR 601-280.
AUTHORITY:
PRINCIPAL
To document reasons for recommendation of non-continuation of service pending rehabilitative process. This information
PURPOSE:
becomes part of the subject's military personnel records which are used to document personnel management actions.
Information may be referred to appropriate authorities if disciplinary action or discharge is appropriate. The DoD Blanket
ROUTINE USES:
Routine Uses that appear at the beginning of the Army's compilation of systems of records may apply to this system.
Voluntary; however, failure to furnish information requested may delay processing the action.
DISCLOSURE:
SECTION I - COMMANDER'S RECOMMENDATION
1.THRU (Soldier being barred)
2.TO (Next higher CDR)
3. FROM (Initiating CDR)
Under the provisions of AR 601-280, I recommend the Soldier named below be barred from Continued Service in the United States Army for
reasons indicated below and in attached documents (if applicable). Prior to submission of this recommendation, the Soldier was counseled
by the undersigned about the undesirable traits which are the basis for this action and advised of the adverse consequences that may ensue from
this or similar action.
4. NAME (Last, First, Middle)
5. RANK
6. BAR INITIATION DATE:
7. ETS:
8. DEROS:
9. TAFS ON BAR INITIATION DATE:
YEARS
DAYS
MONTHS
10. MANDATORY REASONS FOR A BAR TO CONTINUED SERVICE (Supporting documents attached)
a. Un-sat Progress in ABCP
e. Actions Caused Loss of PMOS Qualification (fault of the Soldier)
b. Record APFT Failure (X2)
f. Incident Involving Drugs or Alcohol
c. Removed for cause from NCOES
g. Denied Automatic Integration on the Promotion Standing List
d. UCMJ during Current Term of Service
h. Lost Time During Current Term of Service
Details and description.
11. OTHER REASONS FOR A BAR TO CONTINUED SERVICE (Supporting documents attached)
Details and description.
14. DATE
12. NAME, RANK AND BRANCH OF COMMANDER
13. SIGNATURE
15. ENCLOSURES
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DA FORM 4126, OCT 2016
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
BAR TO CONTINUED SERVICE
For use of this form, see AR 601-280; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AR 601-280.
AUTHORITY:
PRINCIPAL
To document reasons for recommendation of non-continuation of service pending rehabilitative process. This information
PURPOSE:
becomes part of the subject's military personnel records which are used to document personnel management actions.
Information may be referred to appropriate authorities if disciplinary action or discharge is appropriate. The DoD Blanket
ROUTINE USES:
Routine Uses that appear at the beginning of the Army's compilation of systems of records may apply to this system.
Voluntary; however, failure to furnish information requested may delay processing the action.
DISCLOSURE:
SECTION I - COMMANDER'S RECOMMENDATION
1.THRU (Soldier being barred)
2.TO (Next higher CDR)
3. FROM (Initiating CDR)
Under the provisions of AR 601-280, I recommend the Soldier named below be barred from Continued Service in the United States Army for
reasons indicated below and in attached documents (if applicable). Prior to submission of this recommendation, the Soldier was counseled
by the undersigned about the undesirable traits which are the basis for this action and advised of the adverse consequences that may ensue from
this or similar action.
4. NAME (Last, First, Middle)
5. RANK
6. BAR INITIATION DATE:
7. ETS:
8. DEROS:
9. TAFS ON BAR INITIATION DATE:
YEARS
DAYS
MONTHS
10. MANDATORY REASONS FOR A BAR TO CONTINUED SERVICE (Supporting documents attached)
a. Un-sat Progress in ABCP
e. Actions Caused Loss of PMOS Qualification (fault of the Soldier)
b. Record APFT Failure (X2)
f. Incident Involving Drugs or Alcohol
c. Removed for cause from NCOES
g. Denied Automatic Integration on the Promotion Standing List
d. UCMJ during Current Term of Service
h. Lost Time During Current Term of Service
Details and description.
11. OTHER REASONS FOR A BAR TO CONTINUED SERVICE (Supporting documents attached)
Details and description.
14. DATE
12. NAME, RANK AND BRANCH OF COMMANDER
13. SIGNATURE
15. ENCLOSURES
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DA FORM 4126, OCT 2016
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
SECTION II - SOLDIER'S REVIEW
16. I understand that by placing my initials on the line by the statement below I am confirming the action to be true and complete.
a.
I have been counseled and advised of the basis for this action.
b.
I have been furnished a copy of my Commander's recommendation (Section 1) to bar me from Continued Service.
I DO
DO NOT desire to submit a statement in my own behalf (use a continuation sheet if required).
c.
17. NAME AND RANK OF SOLDIER
18. SIGNATURE
19. DATE
SECTION III - NEXT HIGHER COMMAND
20. Unit/Organization
21. I have reviewed Sections I and II and all factual and relevant information (enclosures).
a.
Recommend Approval of the Bar to Continued Service.
(The Bar certificate and enclosures will be forwarded to the next higher commander)
b.
The Bar Certificate is Disapproved.
c.
The Bar Certificate is Approved.
The unit commander will officially counsel the Soldier in writing on the implications of this action and the Soldier's right to appeal. After
counseling, the Bar certificate and enclosures will be forwarded to the servicing Career Counselor (PMOS 79S) for appropriate filing and
administrative actions.
22. NAME AND RANK OF COMMANDER
23. SIGNATURE
24. DATE
SECTION IV - COUNSELING BY INITIATING COMMANDER
25. The Bar to Continued Service initiated against you was approved on
.
26. You understand, if you fail to make progress you may be subject to involuntary separation.
27. You have the right to appeal the imposition of the Bar to Continued Service. If you elect to appeal you must submit the appeal within 7 days of
this counseling.
28. Initial the appropriate block to indicate your option:
b. I will not appeal the Bar to Continued Service.
a. I will appeal the Bar to Continued Service.
If appealing the Bar, my appeal is due to my commander no later than close of business on
.
29. NAME AND RANK OF SOLDIER
30. SIGNATURE
31. DATE
32. NAME AND RANK OF COMMANDER
33. SIGNATURE
34. DATE
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DA FORM 4126, OCT 2016
APD LC v1.00ES
