Da Form 4126 R ≡ Fill Out Printable PDF Forms Online

Da Form 4126 R PDF Details

Have you ever had to fill out the DA Form 4126 R, Record of Medical History? If so, you know that it can be a bit daunting. But don't worry, we're here to help! In this post, we'll explain what each section of the form is for, and provide some tips on how to complete it.

Listed here, you can find some details about da form 4126 r PDF. This site provides details about the form's size, finalization time, and the blanks you can be expected to fill.

Question	Answer
Form Name	Da Form 4126 R
Form Length	2 pages
Fillable?	Yes
Fillable fields	50
Avg. time to fill out	10 min 34 sec
Other names	da form 4126 fillable, fillable da 4126, PSB, reenlistment

12

Form Preview Example

BAR TO REENLISTMENT CERTIFICATE

For use of this form, see AR 601-280; the proponent agency is ODCSPER

1. DATE

2. THRU (Include ZIP Code)

3. TO (Include ZIP Code)

4. FROM (Include ZIP Code)

SECTION I - COMMANDER'S RECOMMENDATION

Under the provisions of Chapter 8, AR 601-280, I recommend the soldier named below be barred from reenlistment in the United States Army for reasons indicated in Item(s) 11 through 14 as may be applicable. Prior to submission of this recommendation, the soldier was counseled by the undersigned about his undesirable traits which are the basis for this action. The soldier has been counseled and advised of the adverse consequences that may ensue from this or similar action.

5.	NAME (Last, First, Middle)		6. SSN					7. RANK

8.	ETS	9. DEROS	10. TOTAL ACTIVE SERVICE COMPUTED FROM BASD TO DATE
			OF BAR INITIATION
					YEARS		MONTHS			DAYS

11.RECORD OF COURT MARTIAL CONVICTIONS (Indicate date adjudicated and approved, type, offense, sentence)

12.RECORD OF NON-JUDICIAL PUNISHMENT (Article 15)(Indicate date, specific offense, sentence and article)

13.RECORD OF NON-PAYMENT OF JUST DEBTS (Indicate dates of letters of indebtedness, counseling, and results)

14. OTHER FACTUAL AND RELEVANT INDICATORS OF UNTRAINABILITY OR UNSUITABILITY

15. TYPED NAME, RANK AND BRANCH OF COMMANDER

16. SIGNATURE

DA FORM 4126-R, DEC 94

EDITION OF MAY 88 IS OBSOLETE

USAPPC V1.00

SECTION II - SOLDIER'S REVIEW (Check and initial as appropriate)

1.I have been furnished a copy of my Commander's recommendation (Sec 1) to bar me from further reenlistment.

2.I have been counseled and advised of the basis for this action.

3.I

do

do not desire to submit a statement in my own behalf. (If applicable, make statement -

use continuation sheet if required.)

4. See attached continuation statement (if applicable)

5. TYPED NAME AND RANK OF SOLDIER

6. SSN

7. SIGNATURE

8. DATE

SECTION III - BATTALION OR NEXT HIGHER COMMAND

1. TO (Include ZIP Code)

2. FROM (Include ZIP Code)

3. I have reviewed Sections I and II and

a. Recommend the soldier be barred from reenlistment.

b. The bar certificate is disapproved.

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, one copy will be provided to the soldier and the original will be forwarded to the servicing PSB for posting filing in the soldier's MPRJ.

4. TYPED NAME AND RANK OF COMMANDER

5. SSN

6. SIGNATURE

7. DATE

SECTION IV - COUNSELING

1. The Bar to Reenlistment initiated against you was approved on

.

2.You have the right to appeal the imposition of the Bar to Reenlistment. If you elect to appeal you must submit the appeal within 7 days from today.

3. Check and initial the appropriate block to indicate your option:

a. I will appeal the Bar to Reenlistment.

b. I will not appeal the Bar to Reenlistment.

4. TYPED NAME AND RANK OF SOLDIER

5. SIGNATURE OF SOLDIER

6. DATE

7. TYPED NAME AND RANK OF COMMANDER

8. SIGNATURE OF COMMANDER

9. DATE

DA FORM 4126-R, DEC 94

Page 2 of 2

USAPPC V1.00

How to Edit Da Form 4126 R Online for Free

Our top computer programmers worked hard to develop the PDF editor we are now happy to present to you. Our software enables you to simply prepare da form 4126 and saves valuable time. You only need to keep up with this procedure.

Step 1: Select the button "Get Form Here" and select it.

Step 2: Once you've entered your da form 4126 edit page, you will notice all actions it is possible to take with regards to your file in the upper menu.

Complete the da form 4126 PDF and enter the material for every part:

V1 empty fields to fill out

Fill out the section with all the particulars asked by the system.

stage 2 to entering details in V1

The system will require you to note certain fundamental info to conveniently submit the part DA FORM 4126, R EDITION OF MAY 88 IS OBSOLETE, and USA, PPC V, 1

Entering details in V1 step 3

Make sure you write down the rights and responsibilities of the sides in the SECTION II - SOLDIER, 'S REVIEW, I have been furnished a copy of my, I have been counseled and advised, I use continuation sheet if, and do not desire to submit a box.

Filling in V1 stage 4

Finalize by analyzing the following fields and preparing them accordingly: SECTION III - BATTALION OR NEXT, Recommend the soldier be barred, The bar certificate is disapproved, The bar certificate is approved, and SECTION IV - COUNSELING.

Entering details in V1 stage 5

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Step 4: It's going to be easier to create duplicates of your file. There is no doubt that we won't display or check out your particulars.

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