Da 1058 R Form PDF Details

Understanding the intricacies of the DA 1058 R form is paramount for soldiers of the Army National Guard aiming for active duty. This form, rooted in the guidelines laid out by NGR 37-111 and dictated by the Privacy Act of 1974, serves as a bridge for members looking to transition into active duty roles, whether for training, special work assignments, or temporary tours. It meticulously records an array of vital information—from personal details, unit assignments, and military qualifications to physical fitness attestations—ensuring that only the most eligible candidates step forward. Notably, the form requires disclosures that play a critical role in scheduling and eligibility determination for various duty types, including active duty for training and annual training. Each submission undergoes a rigorous review process, underscored by the necessity of a commanding officer's endorsement. Beyond its immediate purpose, the form also articulates policies regarding active duty retirement qualifications, painting a comprehensive overview for guard members contemplating an active transition. This exploration peels back the layers of DA 1058 R’s structure and intentions, underscoring its significance in the meticulous planning and execution of National Guard personnel management.

QuestionAnswer
Form NameDa 1058 R Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesngb 1058 1r, da 1058 r pdf, da 1058 r, ngb form 1058 1r

Form Preview Example

APPLICATION FOR ACTIVE DUTY FOR TRAINING, ACTIVE DUTY FOR SPECIAL WORK, TEMPORARY TOUR OF ACTIVE DUTY, ANNUAL

TRAINING, AND FULL-TIME NATIONAL GUARD DUTY FOR SPECIAL WORK FOR SOLDIERS OF THE ARMY NATIONAL GUARD

For use of this form, see NGR 37-111 ; the proponent agency is NGB-ARH-S

 

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY:

10 USC 12301(d) / 32 USC 502(f)

PRINCIPLE PURPOSE:

To determine eligibility and schedule individuals for active duty for special work, Temporary Tours

 

of Active Duty, full-time National Guard duty for special work, active duty for training or additional

 

annual training on requested dates.

ROUTINE USES:

To identify the applicant as a Reserve Component member and to issue active duty

 

for special work for active duty for training orders.

DISCLOSURE:

Completing this form is mandatory for individuals applying for active duty for special

 

work or active duty for training. If not completed, you will not be eligible for the requested tour.

 

PART I - APPLICANT (Read instructions in NGR 37-111 before completing this form.)

1.TO (Include ZIP code)

2.

 

NAME (Last, First, MI)

 

 

3.

SSN

 

 

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)

6.

UNIT OF ASSIGNMENT OR ATTACHMENT

7. GRADE

 

8. BRANCH/MOS

 

9.

SEX

 

10. D.O.B.

11.

MARITAL STATUS

 

12. NO. OF DEPENDANTS

 

 

M

F

 

Single

 

 

13.

PRIMARY SSI (AOC)/MOS

14. DUTY SSI (AOC)/MOS

15.

HEIGHT

 

16. WEIGHT

 

 

 

 

 

 

 

 

17.

 

 

drawing a pension, disability

18.

TOTAL YEARS, MONTHS, DAYS OF ACTIVE FEDERAL SERVICE (AFS)

 

 

I am

I am not

compensation, or retired pay

 

 

 

 

 

 

 

 

from the U.S. Government

 

 

 

 

 

 

 

 

 

 

 

 

19.NAME, RANK AND SIGNATURE OF NGB / STATE / TERRITORY HUMAN RESOURCE OFFICER (or AGR TOUR MANAGER) VERIFYING DATA IN BLOCK 18.

20.DATES OF ADSW / FTNGDSW / TTAD / ADT / AT REQUESTED:

a. FIRST CHOICE

 

b. SECOND CHOICE

 

NUMBER OF DAYS

BEGINNING DATE/TIME

NUMBER OF DAYS

BEGINNING DATE/TIME

LOCATION

 

LOCATION

 

DUTY/TRAINING AGENCY

 

DUTY/TRAINING AGENCY

 

 

 

21. To the best of my knowledge and belief, I am physically qualified for active military service. I was:

a. LAST EXAMINED ON

 

b. AT

 

 

 

22. SIGNATURE

 

23. DATE

 

 

 

 

 

ARNG Format 1058-R, JUL 02

24. REMARKS

"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 FTNGD 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 FTNGD for a period indicated on my order and consent to my release from FTNGD 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/FTNGD service (31-Day Break))

♦ (a) Date of the last day on Active Duty or FTNGD status: _______

 

____

♦

(b) Date new tour of duty to start: ________

 

_______

■ Type of Duty Code (TDC) to be used in fund cite: ______

 

 

 

♦

Number of Days

( subtract b from a ): ____

______

_____________

 

 

 

 

 

PART II - RECORDS CUSTODIAN

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

PAY ENTRY BASIC DATE

26.

SECURITY CLEARANCE

27.

PROMOTION

28. DATE OF RANK

 

 

 

 

 

 

 

 

 

 

CONSIDERATION CODE

 

 

29.

RYE DATE

30.

ETS (Enlisted)

31.

MANDATORY REMOVAL DATE 32. UIC

 

 

 

 

 

 

 

 

 

 

(Officers)

 

 

 

 

 

33. HIV TEST DATE

34. PANOGRAPHIC DENTAL X-RAY ON FILE

YES

NO

35.Preceding Duty: List all AD, TTAD, AT, ADT, IADT, ADSW, FTNGD, FTNGDSW, FTNGD-CD performed in current and previous fiscal year(s), inclusive dates, number of days, type of duty, location of duty and what duty performed. If more space is needed attach additional sheet.

 

a. PERIOD OF PRECEDING DUTY

b. TYPE TRAINING/

 

 

 

 

DUTY (AD, ADSW,

 

 

 

 

FROM

 

TO

NO. DAYS

FTNGDSW etc.)

 

 

 

 

 

NAME AND SIGNATURE OF UNIT COMMANDER

NAME AND SIGNATURE OF RECORDS CUSTODIAN

NAME, SIGNATURE AND TELEPHONE NUMBER OF NGB / STATE / TERRITORY ADSW / FTNGDSW APPROVING AUTHORITY VERIFYING ALL INFORMATION.

DATE

GRADE

c. LOCATION/

d. DUTY

INSTALLATION

PERFORMED

 

 

DATE GRADE TITLE

DATE GRADE TITLE

(Approving official initial appropriate box)

THIS TOUR APPLICATION IS APPROVED

THIS TOUR APPLICATION IS NOT

APPROVED

NAME AND OFFICE OF POC

COMMERCIAL AND DSN TELEPHONE

ARNG Format 1058-R, JUL 02

CHECKLIST FOR DETERMINING THE APPROVAL AUTHORITY FOR ACTIVE DUTY (AD) OR FULL-TIME NATIONAL GUARD DUTY (FTNGD) SPECIAL WORK LONG AND SHORT TOURS OTHER THAN ACTIVE GUARD RESERVE

For the purpose of these questions the terms Active Duty "AD" and Full-Time National Guard Duty "FTNGD" programs refer to ALL short and long tour paid duty programs available to soldiers within the ARNG (i.e. AT, ADT, ADSW, TTAD, FTNGD-CD, FTNGDSW, including AT with unit or service in another components, etc..) other than IDT and RMAs (Tour guidance for ADSW (T-10) is within AR 135-200; FTNGDSW (T-32) is within NGR 37-111, Office of primary responsibility is NGB-ARO-O and NGB-ARH-S respectively).

1.Under what Title and what Program (Title 10 USC/ ADSW or 32 USC/FTNGD) is this tour? _______/_______

2.Will the soldier achieve or does he/she currently have 17 years of AFS prior to / during this tour?

( __No / __Yes — Requires CNGB approval )

3. Will this soldier achieve or does this soldier have 18 years of AFS prior to / during this tour?

( __No / __Yes – Requires CNGB approval )

4.The proposed tour is for how many days? ______________ days.

5.Has the soldier performed any other AD or FTNGD (to include service in other components) within this FY?

(__No / __Yes - How Many Total Days of AD/FTNGD ____________ )

6.If this tour’s cumulative total, in conjunction with all other AD/FTNGD tours, IS LESS THAN 180 days of service this FY, then TAG has approval authority. ( TAG has authority? __Yes / __No )

7.If this tour’s cumulative total, in conjunction with all other AD/FTNGD tours, IS MORE THAN 180 days of service this FY, then CNGB must approve prior to the state publishing orders. ( CNGB must approve? __Yes / _No )

NOTE: Soldiers are not permitted to accumulate six or more years of continuous AFS and become eligible for separation pay (includes all breaks less than 31 days). Breaks in AD/FTNGD programs of less than 31 days do not constitute a valid break in service. A valid break in service is a break of 31 days or more.

8.Does the soldier have four (4) or more years of continuous AFS? ( _Yes – CNGB must approve waiver/ _ No )

9.Does the soldier's tour begin within the first 60 days of the new FY? ( __Yes / __No )

10.If the soldier's tour begins within the FIRST 60 days of the new FY, has the soldier performed MORE THAN 30 days of cumulative AD/FTNGD within the fourth quarter of the preceding FY?

(__Yes ( 60-day break waiver from CNGB is required) / __No )

11.Will the soldier be within six months of MRD or ETS at the BEGINNING of the tour?

( __No / __Yes-Requires CNGB Exception to Policy )

12. The Application(1058) is:

a. For FTNGDSW - Do you possess a copy of the ARNG Format 1058-R which has the signature of the applicant in block 24 for the current tour? ( __Yes- then process / __No-then return for signature) Note: When extending a tour, a new DA Form 1058-R is required for that extension period.

b. For ADSW. Do you possess a copy of the DA Form 1058-R which has the signature of the applicant in block 24 for the current tour? ( __Yes- then process / __No- then return for signature) Note: When extending a tour, a new DA Form 1058-R is required for that extension period.

13. Publishing Orders:

a. For TAG approved tours, retain a copy of this checklist and a copy of the ARNG Format 1058-R and maintain with your file copy of the soldier's tour order.

b. For CNGB level waivers, forward this checklist (to arrive at NGB 45 days prior to desired start date), a copy of the ARNG Format 1058-R, the request for waiver and supporting documents. If approved these documents will be returned and must be maintained with your file copy of the soldier's tour order. If the waiver request is not approved, these documents will be returned with no further

Da 1058 R Form isn’t the one you’re looking for?

Related Documents