DA Form 1696 Vaccine Consent and Assessment

DA Form 1696 - also known as the "Vaccine Consent And Assessment" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 1696 - was last revised on April 1, 2005. Download an up-to-date fillable PDF version of the DA 1696 below or request a copy through the chain of command.

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APPLICATION FOR:
ENLISTMENT/REENLISTMENT QUALIFYING APPLICATION
(SPECIALLY RECRUITED PERSONNEL)
ENLISTMENT
For use of this form, see AR 601-210; the proponent agency is DCS, G-1.
REENLISTMENT
1. NAME (Last, First, Middle Initial)
2. FORMER SERVICE NUMBERS
3. DATE OF BIRTH
4. PHYSICAL PROFILE
5. AFQT TEST AND SCORES
6.
PRIOR ACTIVE FEDERAL SERVICE
COMPONENT OR SERVICE
FROM
TO
MOS CODE
GRADE
YEARS
MONTHS
DAYS
TOTAL ACTIVE FEDERAL SERVICE
7. DESCRIPTION OF MAJOR DUTY ASSIGNMENTS ON ACTIVE DUTY
8.
SERVICE SCHOOL COURSES COMPLETED
YEAR
COURSE
MOS CODE
SCHOOL AND LOCATION
LENGTH OF COURSE
ATTENDED
9.
INACTIVE FEDERAL SERVICE
COMPONENT OR SERVICE
FROM
TO
MOS CODE
GRADE
YEARS
MONTHS
DAYS
TOTAL INACTIVE FEDERAL SERVICE
DA FORM 1696, APR 2005
PREVIOUS EDITIONS ARE OBSOLETE.
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