DA Form 4126 at a glance
What it is: DA Form 4126 is the BAR TO CONTINUED SERVICE form for use under AR 601-280 and DCS, G-1.
Who signs: Box 15 SIGNATURE is signed by the commander in Box 14, NAME, RANK AND BRANCH OF COMMANDER. Box 19 SIGNATURE is signed by the Soldier in Box 18, NAME AND RANK OF SOLDIER. Box 23 SIGNATURE is signed by the legal representative in Box 22, NAME AND RANK OF LEGAL REPRESENTATIVE. Box 28 SIGNATURE is signed by the commander in Box 27, NAME AND RANK OF COMMANDER. Box 35 SIGNATURE is signed by the Soldier in Box 34, NAME AND RANK OF SOLDIER. Box 38 SIGNATURE is signed by the commander in Box 37, NAME AND RANK OF COMMANDER.
In Section I, COMMANDER'S RECOMMENDATION: Under the provisions of AR 601-280, I recommend the Soldier named in Box 4 be barred from continued service in the United States Army for reasons indicated in Boxes 11 and 12 and in attached documents (if applicable).
To document reasons for recommendation of non-continuation of service pending rehabilitative process. This information becomes part of the subject's military personnel records which are used to document personnel management actions. For additional information see the System of Records Notice A0601-280b AHRC SRB https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570079/a0601-280b-ahrc/.
A filled-in DA Form 4126 example: a company commander bars a Soldier
How to fill out DA Form 4126, box by box
Boxes 1 to 3: THRU, TO and FROM
Enter in Box 1 THRU (Soldier being barred), in Box 2 TO (Next higher CDR) and in Box 3 FROM (Initiating CDR).
Boxes 4 to 10, NAME, RANK and BAR INITIATION DATE
Enter in Box 4 the NAME (Last, First, Middle), in Box 5 the RANK and in Box 6 the DoDID.
Enter in Box 7 the BAR INITIATION DATE, in Box 8 the ETS and in Box 9 the DEROS; in Box 10, TAFS ON BAR INITIATION DATE, enter YEARS, MONTHS and DAYS.
Box 11, mandatory reasons for a bar to continued service
Box 11, MANDATORY REASONS FOR A BAR TO CONTINUED SERVICE (Supporting documents attached), lists the reasons below; mark the box for each one that applies: a. Unsatisfactory Progress in ABCP; b. Record ACFT Failure (X2); c. Removed for cause from NCOES; d. UCMJ during Current Term of Service; e. Actions Caused Loss of PMOS Qualification (fault of the Soldier); f. Incident Involving Drugs or Alcohol; g. Denied Automatic Integration on the Promotion Standing List; h. Lost Time During Current Term of Service. Then enter Details and description.
Boxes 12 to 16, other reasons, enclosures and the commander
In Box 12, OTHER REASONS FOR A BAR TO CONTINUED SERVICE (Supporting documents attached), enter Details and description.
Enter in Box 13 the ENCLOSURES.
Sign in Box 15 SIGNATURE; Box 14 is NAME, RANK AND BRANCH OF COMMANDER and Box 16 is DATE.
Section II, Soldier's review, Boxes 17 to 20
In Section II, SOLDIER'S REVIEW, Box 17: the Soldier places initials on the line by each statement to confirm the action to be true and complete.
a. I have been counseled and advised of the basis for this action. b. I have been furnished a copy of my Commander's recommendation (Section 1) to bar me from Continued Service.
c. I DO or DO NOT desire to submit a statement in my own behalf (Use a continuation sheet if required).
Enter in Box 18 the NAME AND RANK OF SOLDIER, in Box 19 the SIGNATURE (sign it) and in Box 20 the DATE.
Section III, next legal review, Boxes 21 to 24
In Section III, NEXT LEGAL REVIEW, Box 21: The Bar to Continued Service packet was reviewed by the servicing legal office on ____.
In Section III, NEXT LEGAL REVIEW: a. I have legal objection to the Bar to Continued Service (Use a continuation sheet if required); b. I have no legal objection to the Bar to Continued Service.
Enter in Box 22 the NAME AND RANK OF LEGAL REPRESENTATIVE, in Box 23 the SIGNATURE (sign it) and in Box 24 the DATE.
Section IV, next higher command, Boxes 25 to 29
In Section IV, NEXT HIGHER COMMAND, enter in Box 25 the UNIT / ORGANIZATION.
In Section IV, NEXT HIGHER COMMAND, Box 26: I have reviewed Sections I and II and all factual and relevant information (enclosures).
In Box 26, a. Recommend Approval of the Bar to Continued Service. (The Bar certificate and enclosures will be forwarded to the next higher commander)
In Box 26, b. The Bar Certificate is Disapproved.
In Box 26, c. The Bar Certificate is Approved. The unit commander will officially counsel the Soldier in writing on the implications of this action and the Soldier's right to appeal. After counseling, the Bar certificate and enclosures will be forwarded to the servicing Career Counselor (PMOS 79S) for appropriate filing and administrative actions.
In Section IV, NEXT HIGHER COMMAND, enter in Box 27 the NAME AND RANK OF COMMANDER, in Box 28 the SIGNATURE (sign it) and in Box 29 the DATE.
Section V, counseling by initiating commander, Boxes 30 to 39
In Section V, COUNSELING BY INITIATING COMMANDER, Box 30: The Bar to Continued Service initiated against you was approved on ____.
In Section V, COUNSELING BY INITIATING COMMANDER, Box 31: You understand, if you fail to make progress you may be subject to involuntary separation.
In Section V, COUNSELING BY INITIATING COMMANDER, Box 32: You have the right to appeal the imposition of the Bar to Continued Service. If you elect to appeal you must submit the appeal within 7 days of this counseling.
In Section V, COUNSELING BY INITIATING COMMANDER, Box 33: Initial the appropriate block to indicate your option: a. I will appeal the Bar to Continued Service. b. I will not appeal the Bar to Continued Service. If appealing the Bar, my appeal is due to my commander no later than close of business on ____.
Enter in Box 34 the NAME AND RANK OF SOLDIER, in Box 35 the SIGNATURE (sign it) and in Box 36 the DATE.
Enter in Box 37 the NAME AND RANK OF COMMANDER, in Box 38 the SIGNATURE (sign it) and in Box 39 the DATE.
Sources
[1] DA Form 4126 (APR 2023), Bar to Continued Service, U.S. Army (the Official source link on this page).
