DA Form 5118 Reassignment Status and Election Statement Page 4

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PART III - SOLDIER STATUS AND ELECTION STATEMENT
INSTRUCTIONS: You will answer all the questions in Part III (Sections F and G). A checkmark in any of the "Yes" blocks will require a comment in the
"Remarks" block indicating the reason for further action, review, or possible removal from this assignment. If a question does not apply, check the "N/A"
block. You must sign the completed statement and return it to the Battalion S1.
1. NAME
2. SSN
3. GRADE
4. PMOS
5. ASI
6. CONTROL LANGUAGE
7. CURRENT UNIT
8. CURRENT UPC
11. TODAY'S DATE (YYYYMMDD)
9. GAINING UNIT
10. EDAS CYCLE NO.
12. ARRIVAL DATE (YYYYMMDD)
13. AI MOS
14. AI ASI
15. AI LANGUAGE
Section F - Personal Status
YES
NO
N/A
59.
Do you have an approved retirement date?
60.
If you are being assigned to an airborne position, do you wish to terminate your airborne status?
61.
Are you being assigned to a duty or an area for which you have a reassignment restriction for the reason of prior
sensitive duty assignment?
62.
Do you have an enlistment or reenlistment commitment for other than the areas of this assignment?
63.
Are you a pregnant Soldier?
64.
Are you a sole parent or married to an Army Soldier?
65.
Is your spouse pregnant?
Do you have an extreme Family situation that meets the requirements outlined in table 2-1, AR 600-8-11?
66.
Section G - To and From OCONUS Status
67.
Do you have any Family members with a physical, emotional, developmental or intellectual disorder who are not
enrolled in the Exceptional Family Member Program?
68.
Have you failed to complete initial entry training (12 weeks military training or its equivalent) required before your
overseas movement?
69.
If you have received assignment instructions to Turkey, are you or your spouse a Turkish or dual U.S.-Turkish
national?
70.
Are you being assigned overseas to a country where you committed a crime that resulted in civil or military
imprisonment or conviction by a foreign tribunal?
71.
Are you being involuntarily reassigned to an unaccompanied short tour area following 12 cumulative months TDY
during a 24-month period?
72.
Do you desire to report in early to the gaining oversea command?
73.
If you have received assignment instructions to a dependent restricted area (short tour area), do you want to
participate in the Homebase Assignment Program?
74.
If you have received assignment instructions to a dependent restricted area (short tour area), do you want to
participate in the Advanced Assignment Program?
75. REMARKS (Annotate any additional information or discrepancies.)
76a. SOLDIER'S SIGNATURE
76b. DATE (YYYYMMDD)
Page 4 of 5
DA FORM 5118, OCT 2012
APD LC v1.00ES

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