Da Form 5160 PDF Details

The DA Form 5160 serves a critical role within the structure of military examinations, specifically designed for in-service examinees. Mandated by the Army Regulation 611-5 and developed by the Deputy Chief of Staff, G-1, this form encapsulates a comprehensive process to ensure that service members are physically and mentally prepared for their respective tests. It collects essential details such as the examinee's name, AKO ID, rank, unit of assignment, and more, to facilitate a controlled and fair testing environment. This form also highlights the examinee's right to opt-out of testing due to extenuating personal circumstances, emphasizing the Army's recognition of the importance of the examinee's well-being on test performance. The examination eligibility section ensures that tests are retaken within permitted time frames, preventing abuse of the testing processes. Moreover, the stated acknowledgment of the consequences for false statements on the form underpins its seriousness, aligning with both the Uniform Code of Military Justice and civilian laws. As such, the DA Form 5160 entrusts both the test examiner and examinee with significant responsibilities, underscoring the integrity and orderliness deemed essential in the evaluation of service members' capabilities and readiness.

QuestionAnswer
Form NameDa Form 5160
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names2009, G-1, AFCT, da form 5160 fillable pdf

Form Preview Example

TEST ADMINISTRATION STATEMENT

For use of this form, see AR 611-5; the proponent agency is DCS, G-1.

FOR IN-SERVICE EXAMINEES ONLY

1.

NAME OF EXAMINEE

 

2.

AKO ID

3.

RANK

4.

DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

5.

UNIT OF ASSIGNMENT

 

 

 

6.

NAME OF TEST OR BATTERY

 

 

 

 

 

 

 

 

7.

NAME OF TEST EXAMINER

 

8.

TEST SITE LOCATION

 

 

9.

TEST ACCOUNT ID

 

 

 

 

 

 

 

 

 

10.I understand that I am not required to take the above named test, this date, provided that there are extenuating circumstances such as fatigue, illness, emotional distress, family, or financial problems, etc., which may interfere with my performance in the test; and that the test will be administered at another time acceptable to me, the Test Control Officer concerned, and my unit commander.

I AM PHYSICALLY AND MENTALLY ABLE TO BE TESTED THIS DATE.

I AM NOT PHYSICALLY AND OR MENTALLY ABLE TO BE TESTED THIS DATE. I WILL BE ADMINISTERED THIS TEST AT ANOTHER TIME.

11.I certify that I am eligible to take this test because:

I HAVE NOT TAKEN A DLPT IN THIS LANGUAGE WITHIN THE LAST SIX MONTHS AS PER AR 611-6.

I HAVE NOT TAKEN THE DLAB WITHIN THE LAST SIX MONTHS, NOR ACHIEVED A SCORE OF 95 OR HIGHER ON A PREVIOUS DLAB TEST, NOR HAVE I TAKEN MORE THAN TWO DLAB TESTS.

I HAVE NOT TAKEN THE AFAST WITHIN THE LAST SIX MONTHS, NOR ACHIEVED A SCORE OF 90 OR ABOVE ON PREVIOUS AFAST TEST, NOR HAVE I TAKEN MORE THAN ONE AFAST TEST.

I HAVE NOT TAKEN THE ASVAB OR THE AFCT WITHIN THE LAST SIX MONTHS, NOR HAVE I TAKEN MORE THAN THREE AFCT TESTS.

I HAVE NOT TAKEN THIS ARMY PERSONNEL TEST WITHIN THE LAST SIX MONTHS AS PER AR 611-5.

- OR -

I HAVE BEEN GRANTED AN EXCEPTION TO POLICY TO RETEST WITHIN SIX MONTHS LIMITATION AND HAVE PROVIDED A COPY OF THE EXCEPTION TO THE TEST CONTROL OFFICER.

Further, I understand that making a false statement on this form may subject me to criminal prosecution under the provisions of Article 107, Uniform Code of Military Justice, or section 1001, Title 18, U.S. Code.

12. SIGNATURE OF EXAMINEE

13. SIGNATURE OF EXAMINER

14.DATE (YYYYMMDD)

DA FORM 5160, SEP 2009

PREVIOUS EDITIONS ARE OBSOLETE.

APD LC v1.00ES

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2. The next part is to fill in these fields: I HAVE NOT TAKEN A DLPT IN THIS, I HAVE NOT TAKEN THE DLAB WITHIN, I HAVE NOT TAKEN THE AFAST WITHIN, I HAVE NOT TAKEN THE ASVAB OR THE, I HAVE NOT TAKEN THIS ARMY, I HAVE BEEN GRANTED AN EXCEPTION, and Further I understand that making a.

Stage no. 2 for filling in da 5160

3. In this particular part, look at SIGNATURE OF EXAMINEE, SIGNATURE OF EXAMINER, DATE YYYYMMDD, DA FORM SEP, PREVIOUS EDITIONS ARE OBSOLETE, and APD LC vES. These will have to be completed with utmost focus on detail.

Best ways to complete da 5160 stage 3

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