DA Form 5118 Reassignment Status and Election Statement Page 5

ADVERTISEMENT

PART IV - WARTIME STATUS
INSTRUCTIONS: You will answer all the questions in Part IV (Section H). 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
8. CURRENT UPC
7. CURRENT UNIT
9. GAINING UNIT
10. EDAS CYCLE NO.
11. TODAY'S DATE (YYYYMMDD)
12. ARRIVAL DATE (YYYYMMDD)
13. AI MOS
14. AI ASI
15. AI LANGUAGE
Section H - Personal Status
YES
NO
N/A
77.
Have you applied for Conscientious Objector status?
78.
Are you a sole surviving son or daughter?
79.
Are you being reassigned to a hostile fire area and have immediate Family members whose service in that area
resulted in death, disability, missing in action, or prisoner of war status?
80.
Are you a former Peace Corps member being reassigned to the country in which you have served?
81.
Are you a former Prisoner of War or Hostage being reassigned to the country where you were held captive?
82.
Have you been hospitalized at least 30 days outside a hostile fire area due to a wound received in that area?
83. REMARKS (Annotate any additional information or discrepancies.)
84a. SOLDIER'S SIGNATURE
84b. DATE (YYYYMMDD)
Page 5 of 5
DA FORM 5118, OCT 2012
APD LC v1.00ES

Download DA Form 5118 Reassignment Status and Election Statement Page 5

1297 times
Rate
(0 / 5) 0 votes

ADVERTISEMENT

Related forms

Page of 5