Army OER Support DA 67-9-1 Form PDF Details

Army OER Support DA 67-9-1 Form is an approval and documentation form used to authorize and document the Army Ombudsmen program. The form provides an administrative means of recording ombudsman actions, communication, recommendations, and status updates. The DA 67-9-1 form also tracks complaints and suggestions from Soldiers and Families within the chain of command. This form must be included in all Ombudsmen case files. If you are an Army Soldier or Family member with a question or concern about the Army ombudspersons program, this is the form you need to know about. Read on for more information about the Army OER Support DA 67-9-1 Form.

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QuestionAnswer
Form Name Army Oer Support Da 67 9 1 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names army form oer support, officer evaluation report form army, support form oer army, form oer

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OFFICER EVALUATION REPORT SUPPORT FORM

FOR OFFICIAL USE ONLY (FOUO)

SEE PRIVACY ACT STATEMENT IN

For use of this form, see AR 623-3

; the proponent agency is DCS, G-1.

AR 623-3.

 

 

 

 

 

PART I - RATED OFFICER IDENTIFICATION

NAME OF RATED OFFICER (Last, First, MI)

SSN

RANK

DATE OF RANK (YYYYMMDD)

BRANCH

DESIGNATED/PMOS (WO) SPECIALITIES

UNIT, ORG., STATION ZIP CODE OR APO, MAJOR COMMAND

STATUS CODE

FROM DATE

UIC

CMD CODE PSB CODE

PART II - AUTHENTICATION

NAME OF RATER (Last, First, MI)

SSN

RANK

POSITION

NAME OF INTER. RATER (Last, First, MI)

SSN

RANK

POSITION

NAME OF SENIOR RATER (Last, First, MI)

SSN

RANK

POSITION

PART III - VERIFICATION OF FACE-TO-FACE DISCUSSION

MANDATORY RATER / RATED OFFICER INITIAL FACE-TO-FACE COUNSELING ON DUTIES, RESPONSIBILITIES AND PERFORMANCE OBJECTIVES FOR THE

CURRENT RATING PERIOD TOOK PLACE ON(Date) Rated Soldier InitialsRater InitialsSenior Rater Initials (Review)

PERIODIC RATER / RATED OFFICER FOLLOW-UP FACE-TO-FACE COUNSELINGS:

Dates

 

Rated Soldier Initials

 

Rater Initials

 

Senior Rater Initials

 

 

 

(Review)

 

 

 

 

 

 

 

 

 

 

 

 

 

PART IV - RATED OFFICER (Complete Part IV and Part V below for this rating period)

PRINCIPAL DUTY TITLE

POSITION AOC / BR

 

 

a. STATE YOUR SIGNIFICANT DUTIES AND RESPONSIBILITIES:

b. INDICATE YOUR MAJOR PERFORMANCE OBJECTIVES:

DA FORM 67-9-1, OCT 2011

PREVIOUS EDITIONS ARE OBSOLETE.

Page 1 of 2

APD PE v1.00ES

 

NAME

SSN

PART V - RATED OFFICER CONTRIBUTIONS

A. APFT:DATE:HEIGHT:WEIGHT:

b. LIST YOUR SIGNIFICANT CONTRIBUTIONS:

c. LIST ANY UNIQUE PROFESSIONAL SKILLS OR AREAS OF EXPERTISE OF VALUE TO THE ARMY:

d. IF UNABLE TO SERVE IN THE CURRENT BRANCH/CAREER FIELD, IN WHICH BRANCH/CAREER FIELD WOULD YOU PREFER TO SERVE?

e. LIST 3 FUTURE ASSIGNMENTS FOR WHICH YOU FEEL YOU ARE BEST SUITED:

SIGNATURE AND DATE

DA FORM 67-9-1, OCT 2011

Page 2 of 2

APD PE v1.00ES

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