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| Question | Answer |
|---|---|
| Form Name | Da 4187 1 R Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 4187 r, fillable 4187, da r 1 4187, 4187 fillable pdf |
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PERSONNEL ACTION FORM ADDENDUM |
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For use of this form see AR |
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1. NAME OF INDIVIDUAL |
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2. SSN |
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3.RECOMMENDATIONS FOR APPROVAL/DISAPPROVAL
a. |
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(1) ORGANIZATION |
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(2) |
OFFICE SYMBOL |
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(3) DATE |
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(4) |
ACTION |
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APPROVED |
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DISAPPROVED |
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RETURNED |
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(5) |
COMMENTS |
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(6) |
NAME |
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(7) |
TITLE/POSITION/RANK |
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(8) |
SIGNATURE |
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(9) |
HEADQUARTERS POC TELEPHONE NUMBER |
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(10) FORWARDED TO |
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(11) ENCLOSURES |
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ADDED |
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WITHDRAWN |
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NO CHANGE |
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b. |
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(1) ORGANIZATION |
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(2) |
OFFICE SYMBOL |
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(3) DATE |
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(4) |
ACTION |
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APPROVED |
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DISAPPROVED |
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RECOMMEND APPROVAL |
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RECOMMEND DISAPPROVAL |
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RETURNED |
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(5) |
COMMENTS |
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(6) |
NAME |
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(7) |
TITLE/POSITION/RANK |
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(8) |
SIGNATURE |
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(9) |
HEADQUARTERS POC TELEPHONE NUMBER |
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(10) FORWARDED TO |
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(11) ENCLOSURES |
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ADDED |
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WITHDRAWN |
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NO CHANGE |
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c. |
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(1) ORGANIZATION |
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(2) |
OFFICE SYMBOL |
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(3) DATE |
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(4) |
ACTION |
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APPROVED |
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DISAPPROVED |
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RECOMMEND APPROVAL |
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RECOMMEND DISAPPROVAL |
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RETURNED |
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(5) |
COMMENTS |
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(6) |
NAME |
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(7) |
TITLE/POSITION/RANK |
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(8) |
SIGNATURE |
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(9) |
HEADQUARTERS POC TELEPHONE NUMBER |
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(10) FORWARDED TO |
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(11) ENCLOSURES |
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ADDED |
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WITHDRAWN |
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NO CHANGE |
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4. |
DISTRIBUTION |
(List all organizations to receive copy) |
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DA FORM
USAPPC V1.10