DA Form 1058 at a glance
What it is: DA Form 1058 is the Application for Active Duty for Training, Active Duty for Operational Support, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve.
Who signs: The applicant signs under SIGN.
The form is used as a voluntary request for training and determines the eligibility of Soldiers, and to schedule individuals for other training duty (OTD), active duty for operational support (ADOS), and annual training (AT) on specified requested dates.
What to bring and attach to DA Form 1058
Read instructions in AR 135-200 before completing this form.
A filled-in DA Form 1058 example: an IMA soldier requests annual training
How to fill out DA Form 1058, box by box
1. TO, 2a. NAME and 2b. RESERVE COMPONENT CATEGORY
Enter 1. TO and include the ZIP Code.
Enter 2a. NAME as Last, First, MI.
Under 2b. RESERVE COMPONENT CATEGORY, check IMA, IRR, TPU, ARNG or ARNGUS.
3a. PERMANENT HOME ADDRESS and 4a. ADDRESS FROM WHICH YOU WILL REPORT FOR DUTY
Enter 3a. PERMANENT HOME ADDRESS and include the ZIP Code.
Enter 4a. Address from which you will report for duty if different from permanent home address, and include the ZIP Code.
Enter 3b. and 4b. PRIMARY TELEPHONE NUMBER and include the area code.
Enter 3c. and 4c. SECONDARY TELEPHONE NUMBER and include the area code.
5. UNIT OF ASSIGNMENT OR ATTACHMENT AND UIC, 6. GRADE and 7. BRANCH
Enter 5. Unit of assignment or attachment and UIC.
Enter 6. GRADE and 7. BRANCH.
8. SEX, 9. DOB, 10. MARITAL STATUS and 11. NO. OF DEPENDENTS
Under 8. SEX, check Male or Female.
Enter 9. DOB (YYYYMMDD), 10. MARITAL STATUS and 11. NO. OF DEPENDENTS.
12. PRIMARY SSI (AOC) / MOS, 13. DUTY SSI (AOC) / MOS, 14. AFT DATE and 15. WHtR
Enter 12. PRIMARY SSI (AOC) / MOS and 13. DUTY SSI (AOC) / MOS.
Enter 14. AFT DATE and 15. WHtR.
I am or I am not drawing a pension and 17. TOTAL YEARS, MONTHS, DAYS OF ACTIVE FEDERAL SERVICE (AFS)
Check one of two boxes: I am drawing, or I am not drawing, a pension, disability compensation, or retired pay from the U.S. Government.
Enter 17. TOTAL YEARS, MONTHS, DAYS OF ACTIVE FEDERAL SERVICE (AFS).
18. FOR INDIVIDUAL MOBILIZATION AUGMENTEES ONLY: THIS APPLICATION IS FOR
Check one under 18. for individual mobilization augmentees only: this application is for: IMA AT, IMA AT w/IDT, ADT in lieu of IMA AT or Additional ADT.
19. DATES OF ADOS / TTAD / ADT / AT REQUESTED
Under 19. DATES OF ADOS / TTAD / ADT / AT REQUESTED, a. FIRST CHOICE, enter the NUMBER OF DAYS and the BEGINNING DATE / TIME.
Under b. SECOND CHOICE, enter the NUMBER OF DAYS and the REPORT DATE (YYYYMMDD).
Enter the LOCATION and include the Zip Code.
Enter the DUTY / TRAINING AGENCY AND UIC.
Signature of applicant
"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."
Sign under SIGN (Signature of applicant).
More rules for DA Form 1058
For use of this form, see AR 135-200; the proponent agency is DCS, G-1.
Voluntary, however failure to complete this form will make you ineligible for consideration for OTD, ADOS, or AT.
Applicant should retain a copy of DA Form 1058.
Sources
[1] DA Form 1058 (OCT 2020), Application for Active Duty for Training, Active Duty for Operational Support, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve, U.S. Army (the Official source link on this page).