IN AND OUT PROCESSING CHECKLIST
NAME (Last, First, Middle) SSN: ACCESSION FROM :
RANK: MOS/AOC: PREVIOUS UNIT (If applicable)
PHONE: HOME ADDRESS (If PO Box, Write both) UNIT NAME:
PHONE: UNIT ADDRESS:
PHONE:
AKO E-MAIL: ALT E-MAIL: UNIT POC (PHONE):
CAC CARD
PIN Y/N
CAC WORKS
INTERNET ACCESS?
AKO COUNSELING DATED:
PERSONAL INFORMATION
DOB: ETHNICITY: RELIGION:
FAM CARE PLAN REQ?
# OF DEPENDANTS:
CHILD CUSTODY PAYMENT/MO: FAM CARE PLAN DATE:
EMPLOYMENT INFORMATION
EMPLOYER AND ADDRESS: SUPERVISOR: E-MAIL:
TITLE AND BRIEF DESCRIPTION:
PHONE: FIELD (General):
SERVICE INFORMATION
PEBD: MSO: RETIRE YEARS: OES/NCOES COMPL: ERB/ORB/DA 2-1 DATED:
DT COMM/WO COMM:
ETS: YRS AD: OES/NCOES NEED:
COPY OF ASSIGN ORDERS DATED:
MEDICAL
CAPOC PHA DATED: HIV DATE:
PRIMARY MEDICAL CONCERNS: LOD? MMRB? PDHRA?
NEED PROFILE?
RECORDS COMPLETE? MODS RVW
POSITION INFORMATION
SQUAD ASSIGNMENT: POSITION:
MOSQ? QUAL FOR SCHOOL? ASI/SQI QUAL? QUAL FOR SCHOOL?
EVALUATION AND COUNSELING
LAST EVAL THRU DATE:
LAST RATER: LAST RATER AKO: LAST EVAL AT HRC: LAST EVAL DUE:
INITIAL COUNSELING (2166-8-1, 67-9-1, 4856) DATED:
RATER: SR RATER: NEXT EVAL DUE:
MISSING EVALUATIONS: RLAS DATE: ITRS DATE:
TRAINING
LAST APFT: P/U SCORE: S/U SCORE: RUN SCORE: ALT EVENT? PASS OR FLAG
LAST HT/WT: HT: WT: DA 5500/5501? FAT % PASS OR FLAG
LAST WPN QUAL: ALT WPN QUAL: MOS SPECIFIC MANDATORY TRAINING? DUE?
SUICIDE PREV. PH 1 DTD: SUICIDE PREV. PH 2 DTD: AT LEVEL 1 DATED:
CRM-B DATED:
SERE 100/B DATED:
IAA (DOD):
HQ REPRESENTATIVE: SIGN: DATE:
FINANCE
MYPAY?
SUREPAY? SF 1199 ON RECORD
LIST SUPPORTING DOCUMENTS NEEDED:
DA 5960 DATED: BONUS DUE? BONUS SUPPORTING DOCUMENTS NEEDED:
CITIZENSHIP:
Na>ve / Naturalized / Deriv / Not
MARITAL STATUS:
Sing. / Marr. / Div.
MILITARY SPOUSE? IF YES, SPOUSE SSN:
YES / NO - -
DENTAL CLASS:
DATED:
VISION SCRN:
DATED:
VOUCHERS REQUIRED:
DATE SCHED:
MTOE POSITION: TITLE:
POSN: PARA: LIN: MOS/AOC:
