The Department of Defense Form 5187 is also known as the DD Form 5187 and it is a document that is used by military members to apply for a dependent ID card. The form can be used by both active duty and reserve military members, and it must be completed and submitted in order to get a dependent ID card. The form requires basic information about the applicant, such as name, date of birth, social security number, and rank. The form must also include information about the dependent for whom the ID card is being requested, such as name, date of birth, and relationship to the applicant. There are several copies of the form available online, so it's important to download the correct version for your specific situation. The Department
| Question | Answer |
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| Form Name | Da Form 5187 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 00ES, amazon, CAREGIVERS, RESPITE |
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APPLICATION FOR RESPITE CAREGIVERS |
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For use of this form, see AR |
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DATA REQUIRED BY THE PRIVACY ACT |
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AUTHORITY: |
Title 5, United States Code, Section 301. |
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PRINCIPAL PURPOSE: |
To recruit and select respite caregivers. |
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ROUTINE USES: |
To determine the prospective respite caregiver's ability to care for individuals with disabilities. |
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DISCLOSURE: |
Providing information is voluntary. Failure to provide information will result in disapproval of prospective respite |
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caregiver's application. |
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1. NAME |
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2. BIRTHDATE |
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3. MAIDEN NAME (Applicant or spouse)
4. SPOUSE'S NAME
5. ADDRESS (Street, city and state) (Include ZIP Code)
6.TELEPHONE NO. HOME:
OFFICE:
7. BRIEFLY DESCRIBE BACKGROUND, INTEREST, AND/OR EXPERIENCE WORKING WITH CHILDREN OR ADULTS WITH DISABILITIES
8. AVAILABILITY FOR PROVIDING CARE
EVENINGS
DAYS YES NO
YES
NOWEEKENDS
YES
NO
WILL PROVIDE CARE:
OVERNIGHT WEEKDAYS
IN HOME OF CLIENT
YES
NO |
OVERNIGHT WEEKENDS |
YES |
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IN MY OWN HOME |
NO PREFERENCE |
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NO
9. DO YOU HAVE OWN TRANSPORTATION? |
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10. AGE GROUP PREFERENCE |
YES |
NO |
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11. EDUCATION (High school, college, graduate studies, other)
NAME AND ADDRESS OF SCHOOL
DATES ATTENDED
MAJOR
DEGREE
12. EMPLOYMENT (Present, and last three years)
NAME AND ADDRESS OF EMPLOYER
DATES EMPLOYED
POSITION
13. REFERENCES (List three, other than relative. Example: Pastor, supervisor,
NAME AND ADDRESS (Give complete mailing address) (Include ZIP Code)
OCCUPATION
I hereby certify that all statements in this application are true to the best of my knowledge and belief.
SIGNATURE |
DATE (YYYYMMDD) |
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DA FORM 5187, JUN 2009 |
PREVIOUS EDITIONS ARE OBSOLETE. |
APD PE v1.00ES |