At the heart of recognizing and managing the invaluable contributions of volunteers within the Army Community Service (ACS) lies the DA Form 4162, an essential tool designed to meticulously record and track the voluntary services rendered by individuals. Governed by AR 608-1 and backed by legal mandates from both the Department of the Army and federal regulations, this form serves multiple key purposes. It collects crucial background information, assisting in the proper assignment of tasks according to a volunteer's qualifications. Not only does it keep a detailed account of positions held and hours volunteered, but it also notes any training undertaken and awards received, thereby ensuring a comprehensive service record. The form emphasizes the importance of privacy, adhering strictly to the Privacy Act Statement, which outlines the voluntary nature of disclosure and the specific authority under which the form operates. Moreover, the DA Form 4162 facilitates a smooth transition process for volunteers moving within the system, whether due to resignation, retirement, or transfer, by mandating the maintenance of records and the provision of copies to relevant parties. This form, therefore, not only functions as a record-keeping mechanism but also as a vital tool for recognition and organization within the Army's volunteer program.
| Question | Answer |
|---|---|
| Form Name | Da 4162 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | fillable form da 4162, da 4162 2003, 13 da 4162 print, 13 da 4162 pdf |
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VOLUNTEER SERVICE RECORD |
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For use of this form, see AR |
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PRIVACY ACT STATEMENT |
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AUTHORITY: |
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5 USC Section 301, Department Regulations; 10 USC Section 3013, Secretary of the Army; and Army Regulation |
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PRINCIPAL PURPOSE: |
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To record essential background information on volunteers to assist in determining qualifications and task |
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assignments. To maintain record of positions held, hours volunteered, training and awards received. |
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ROUTINE USES: |
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None. The "Blanket Routine Uses" set forth at the beginning of the Army's Complications of System of Records |
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Notices apply to this system. |
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DISCLOSURE: |
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Voluntary. However, failure to provide the requested information may exclude you from participating in the Army |
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Community Service Volunteer Program. |
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INSTRUCTIONS: Upon resignation, retirement or transfer, the original of this record will be furnished for the personal file of the volunteer and a duplicate |
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will be maintained at the organization for at least three years. In case of transfer, a duplicate record will be furnished to the gaining organization upon |
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request of the volunteer. |
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1. NAME OF VOLUNTEER (Last, First, MI) |
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2. HOME ADDRESS (Street, City, State and ZIP Code) |
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3. EMAIL ADDRESS |
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4. TELEPHONE NUMBERS |
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5. SEX |
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a. HOME |
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MALE |
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FEMALE |
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b. WORK |
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6. DATE OF BIRTH (YYYYMMDD) |
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c. FAX |
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7a. SPONSOR NAME |
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7b. SPONSOR UNIT ADDRESS |
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8. Mark all the demographic data that applies to the volunteer. Family members of service members should indicate the branch of service and status of |
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the sponsor. |
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SERVICE MEMBER |
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ARMY |
AIR FORCE |
NAVY |
MARINE |
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CIVILIAN EMPLOYEE |
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OFFICER |
ENLISTED |
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(APF and NAF) |
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ADULT FAMILY MEMBER |
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ACTIVE DUTY |
RETIRED |
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YOUTH FAMILY MEMBER |
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RESERVE |
GUARD |
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(Under age 18 and unmarried) |
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CIVILIAN (Not connected with |
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DECEASED |
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the military) |
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9. CHILDREN AT HOME |
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10. INITIAL COMMITMENT |
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NONE |
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PRESCHOOL |
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IN SCHOOL |
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ONE DAY EVENT |
ONE MONTH EVENT |
THREE MONTHS |
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11. EDUCATION |
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ADVANCED |
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HIGH SCHOOL |
COLLEGE |
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SIX MONTHS |
NINE MONTHS |
OTHER |
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DEGREE |
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12. WORK EXPERIENCE |
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13. VOLUNTEER EXPERIENCE |
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DA FORM 4162, JUL 2003 |
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DA FORM 4162, MAY 1999, IS OBSOLETE. |
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Page 1 of 2 |
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APD PE v1.00
14. SPECIAL SKILLS, INTEREST, HOBBIES
15. POSITIONS HELD
START DATE
TYPE OF POSITION
(YYYYMMDD)
END DATE
(YYYYMMDD)
16. AWARDS AND SPECIAL RECOGNITION
DATE |
TYPE OF AWARD/SPECIAL RECOGNITION |
PRESENTED AT |
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(YYYYMMDD)
17. TRAINING
DATE
(YYYYMMDD)
TYPE OF TRAINING
HOURS
COMPLETED
18.VOLUNTEER ANNUAL HOUR RECORD YEAR
HOURS
19a. SIGNATURE
DA FORM 4162, JUL 2003
19b. DATE (YYYYMMDD)
Page 2 of 2
APD PE v1.00