Da Form 1058 1R PDF Details

The DA Form 1058 1R serves as a critical application used by soldiers of the Army National Guard and U.S. Army Reserve when applying for various types of active duty, including training, special work, temporary tours, and annual training. Mandated by the regulations detailed in AR 135-200 and governed under the authority of 10 USC 672(d) and USC 275, this form is essential for determining eligibility, scheduling, and documenting members of the Reserve Component seeking to enter active duty status for specified purposes. The DA 1058 1R encapsulates vital personal and service-related information, ranging from personal identification details to professional military data such as unit assignment, grade, branch, and service history. Applicants must disclose their physical readiness and any federal pensions or disability compensations they receive. Additionally, it addresses the administrative process for scheduling active duty periods, emphasizing the applicant's responsibility to provide accurate information regarding their physical condition and willingness to accept release from active duty upon completion of their tour, unless retention is deemed beneficial for the Army. This form not only serves as an application but also acts as a formal agreement between the soldier and the Army, highlighting its significance in managing Army personnel and their active duty commitments.

QuestionAnswer
Form NameDa Form 1058 1R
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names1058 form, da 1058 r, 1058r form, 1058 r

Form Preview Example

APPLICATION FOR ACTIVE DUTY FOR TRAINING, ACTIVE DUTY FOR SPECIAL WORK, TEMPORARY TOUR OF ACTIVE DUTY, AND ANNUAL TRAINING FOR SOLDIERS OF THE ARMY NATIONAL GUARD AND U.S. ARMY RESERVE

For use of this form, see AR 135-200; the proponent agency is DCS, G-1.

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: 10 USC 672(d) and USC 275.

PRINCIPAL PURPOSE: To determine eligibility and schedule individuals for active duty for special work or active duty for training on requested dates.

ROUTINE USES:

To identify the applicant as a Reserve Component member and to issue active duty for special work or

 

active duty for training orders.

DISCLOSURE:

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

 

for training. If not completed, you will be ineligible for the requested tour.

PART I - APPLICANT (Read instructions in AR 135-200 before completing this form.)

1.TO (Include ZIP Code)

2.NAME (Last, First, MI)

3a. PERMANENT HOME ADDRESS (Include ZIP Code)

4a. ADDRESS FROM WHICH YOU WILL REPORT FOR DUTY (If

 

different from permanent home address) (Include ZIP Code)

3b. HOME TELEPHONE NUMBER (Include area code)

4b. HOME TELEPHONE NUMBER (Include area code)

 

 

 

3c. BUSINESS TELEPHONE NUMBER (Include area code)

4c. BUSINESS TELEPHONE NUMBER (Include area code)

 

 

 

 

5.

UNIT OF ASSIGNMENT OR ATTACHMENT

6. GRADE

7. BRANCH

 

 

 

 

 

8.

SEX

9. DOB

10. MARITAL STATUS

11. NO. OF DEPENDENTS

 

Male

Female

 

 

12. PRIMARY SSI (AOC) /MOS

13. DUTY SSI (AOC) /MOS

14. HEIGHT

15. WEIGHT

16.

I am

I am not

drawing a pension, disability compensation,

 

or retired pay from the U.S. Government.

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

18. FOR INDIVIDUAL MOBILIZATION AUGMENTEES ONLY: THIS APPLICATION IS FOR (Check one)

IMA AT

ADT in lieu of IMA AT

Additional ADT

19. DATES OF ADSW/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

20.To the best of my knowledge and belief, I am physically qualified for active military duty. I was

a. LAST EXAMINED ON

b. AT

21. SIGNATURE

22. DATE

DA FORM 1058-R, JUL 2010

PREVIOUS EDITIONS ARE OBSOLETE.

APD PE v1.00ES

 

23. 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 active duty at the completion of my tour unless continued retention on active duty is considered in the best interest of the Army by the Assistant Secretary of the Army (Manpower and Reserve Affairs) . I hereby consent to my release from active duty at the completion of this tour.

(Signature of applicant)

PART II - RECORDS CUSTODIAN

24.

PAY ENTRY BASIC DATE

25.

SECURITY CLEARANCE

26. PROMOTION

 

27.

DATE OF RANK

 

 

 

 

CONSIDERATION CODE

 

 

 

 

 

 

 

 

 

28.

RYE DATE

29.

ETS (Enlisted)

30. MANDATORY REMOVAL

31.

UIC

 

 

 

 

DATE (Officers)

 

 

 

 

 

 

 

 

 

 

 

32.

HIV TEST DATE

 

 

 

 

 

 

 

 

33.

PANOGRAPHIC DENTAL X-RAY ON FILE

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.List all previous AD, TTAD, AT, ADT, IADT, and ADSW in the previous and current fiscal year showing inclusive dates, purpose of tours, and HQ or agency to which attached.

a. PERIOD OF TRAINING/DUTY

FROM

TO

NO.

DAYS

 

 

 

 

 

b.TYPE TRAINING/ DUTY

(AD, TTAD, etc.)

c.LOCATION/ INSTALLATION

d.DUTY

PERFORMED

e. SIGNATURE OF UNIT COMMANDER

f. DATE

35a. NAME OF RECORDS CUSTODIAN ( Last, First, MI)

b. GRADE

c. SIGNATURE

d. DATE

REVERSE, DA FORM 1058-R, JUL 2010

APD PE v1.00ES

How to Edit Da Form 1058 1R Online for Free

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This PDF will require particular details to be entered, so ensure that you take the time to provide precisely what is asked:

1. It is recommended to complete the form 1058 properly, hence be careful while filling out the sections comprising all these blanks:

Step # 1 of filling out da form 1058 r fillable

2. After the last section is completed, you have to include the needed details in FOR INDIVIDUAL MOBILIZATION, IMA AT, ADT in lieu of IMA AT, Additional ADT, DATES OF ADSWTTADADTAT REQUESTED, NUMBER OF DAYS, BEGINNING DATETIME, NUMBER OF DAYS, BEGINNING DATETIME, a FIRST CHOICE, b SECOND CHOICE, LOCATION, LOCATION, DUTYTRAINING AGENCY, and DUTYTRAINING AGENCY so you can go further.

da form 1058 r fillable writing process described (stage 2)

3. Through this step, check out I understand that although at the, Signature of applicant, PAY ENTRY BASIC DATE, SECURITY CLEARANCE, PROMOTION CONSIDERATION CODE, DATE OF RANK, PART II RECORDS CUSTODIAN, RYE DATE, ETS Enlisted, MANDATORY REMOVAL DATE Officers, UIC, HIV TEST DATE, PANOGRAPHIC DENTAL XRAY ON FILE, YES, and List all previous AD TTAD AT ADT. These will have to be completed with utmost awareness of detail.

da form 1058 r fillable completion process shown (stage 3)

Be really attentive while completing Signature of applicant and List all previous AD TTAD AT ADT, since this is the part in which many people make some mistakes.

4. This next section requires some additional information. Ensure you complete all the necessary fields - FROM, NO DAYS, AD TTAD etc, c LOCATION INSTALLATION, PERFORMED, e SIGNATURE OF UNIT COMMANDER, f DATE, a NAME OF RECORDS CUSTODIAN Last, and b GRADE - to proceed further in your process!

da form 1058 r fillable writing process shown (part 4)

5. Finally, the following final part is what you should finish before closing the form. The blank fields in question are the following: c SIGNATURE, d DATE, REVERSE DA FORM R JUL, and APD PE vES.

da form 1058 r fillable writing process shown (part 5)

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