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VOLUNTARY ADOS Checklist Version 8
VOLUNTARY ADOS Checklist Version 8
NAME: DATE:
UNIT:
STATEMENT OF NEED:
Verification of security clearance memorandum from the State Security Manager, within 30
days of application date
DA Form 705 (Army Physical Fitness Test Scorecard) with Record-Go APFT score, within 60
days of application date.
DA 5500 or 5501 (Body Fat Content Worksheet), within 6 months of application start date
DA Form 1506 (Statement of Service), covering all active service over the last four years
(IF APPLICABLE) This Technician Supervisor approves SM request for long-term ADOS.
(IF APPLICABLE) This hiring agency accepts SM requesting to perform long-term ADOS, and agrees
to allow SM to perform IDT and AT unless prior coordination has been made.
1
PAARNG ADOS Form
PAARNG ADOS FORM
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PRINCIPLE PURPOSE: To determine eligibility and schedule individuals for active duty operational support (ADOS)
ROUTINE USES: To identify the applicant as a Reserve Component member and to issue active duty
operational support orders.
DISCLOSURE: Completing this form is mandatory for individuals applying for active duty operational support.
If not completed, applicant will not be eligible for the requested tour.
PART I - APPLICANT
1. TO
JFHQ-G3
2. NAME (Last, First, MI) 3. SSN
d
4a. PERMANENT HOME ADDRESS (Include ZIP code) 5a. ADDRESS FROM WHICH YOU WILL REPORT FOR DUTY (if
different from permanent home address) (include ZIP code)
4b. HOME TELEPHONE NUMBER (Include area code) 5b. HOME TELEPHONE NUMBER (Include area code)
4c. BUSINESS TELEPHONE NUMBER (Include area code) 5c. BUSINESS TELEPHONE NUMBER (Include area code)
13. PRIMARY SSI (AOC)/MOS 14. DUTY SSI (AOC)/MOS 15. HEIGHT 16. WEIGHT
19. SIGNATURE OF JFHQ HUMAN RESOURCE OFFICER VERIFYING ADMIN DATA IN BLOCK 18
LOCATION LOCATION
21. To the best of my knowledge and belief, I am physically qualified for active military service. I was:
"I understand that, although at the completion of my tour, I may be within 2 years of qualifying for an active duty
retirement under 10 USC 1293, 3911, or 3914, it is current Army policy that I will be released from ADOS at the completion
of my tour unless I am offered a follow-on tour as approved by CNGB. I hereby waive sanctuary and consent to being
ordered to ADOS for a period indicated on my order and consent to my release from ADOS at the completion of this tour."
______________________________________________________
(Signature of applicant)
(THIS ACTION WILL NOT BE APPROVED WITHOUT THE SOLDIER’S SIGNATURE IN THIS BLOCK)
____________________________________________________________________________________________________________________
ADDITIONAL REMARKS:
■ Identify Break In Service. (Used to compute / verify days elapsed since last active duty operational support tour (31-Day Break))
♦ (a) Date of the last day on ADOS status: .. ♦ (b) Date new tour of duty to start:
25. PAY ENTRY BASIC DATE 26. SECURITY CLEARANCE 27. DATE OF RANK
28. RYE DATE 29. ETS (Enlisted) 30. MANDATORY REMOVAL DATE (Officers)
33. Preceding Duty: List all AD performed within the past 4 years. NGB FORM 23A must be attached IF number of points exceed 730 days.
NAME, SIGNATURE AND TELEPHONE NUMBER OF STATE ADOS APPROVING AUTHORITY (Approving official check appropriate box)