Da Form 61 – Fill Out and Use This PDF

Da Form 61 – Fill Out and Use This PDF

Da Form 61 PDF Details

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Da Form 61 PDF Details

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Da Form 61 PDF Details

One of the most common forms used in the military is the DA Form 61, also known as the "Equipment Verification and Condition Report". This form is used to document the condition of a unit's equipment, and to help identify any problems or issues that need to be addressed. The form is typically filled out by the unit commander or first sergeant, and can be used as part of an equipment inspection checklist. It's important to keep accurate records of your equipment's condition so that you can track any necessary repairs or replacements.

Question	Answer
Form Name	Da Form 61
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	da form 61, da 61, army appointment applicant, fillable da 61

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APPLICATION FOR APPOINTMENT

For use of this form, see AR 135-100, AR 145-1, AR 351-5, and AR 601-100; the proponent agency is DCSPER

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: Title 10 United States Code, Section 3012 (Title 5 United States Code, Section 552a)

PRINCIPAL PURPOSE: To obtain an appointment as a commissioned or warrant officer in the Regular Army or Army Reserve, or to obtain selection to attend the US Army Officer Candidate School.

ROUTINE USES: Basis for determination of qualifications and background information for eligibility for consideration for appointment as a Regular Army or Army Reserve commissioned/warrant officer or for selection for attendance at the US Army Officer Candidate School.

DISCLOSURE

Disclosure of information requested in DA Form 61 is voluntary. Failure to provide the required information will result in non-acceptability of the application.

2. GOVERNING REGULATION OR CIRCULAR (Specify appropriate section(s) if applicable)

1.TYPE OF APPOINTMENT FOR WHICH APPLICATION IS SUBMITTED

COMMISSIONED OFFICER - REGULAR ARMY

GRADE FOR WHICH APPLYING (Reserve appointments only)

COMMISSIONED OFFICER - ARMY RESERVE

SOURCE OF APPLICATION (ROTC only)

WARRANT OFFICER - REGULAR ARMY

DMG

DATE DESIGNATED:

WARRANT OFFICER - ARMY RESERVE

SCHOLARSHIP - ENTER 1, 2, 3 OR 4 YEARS:

OFFICER CANDIDATE SCHOOL

5. ONLY FOR APPLICANTS FOR APPOINTMENT AS WARRANT OFFICERS

6. BRANCH AND SPECIALTY PREFERENCES

(List choice by MOS code and title)

a. MOS CODE

b. MOS TITLE

Regular Army and Officer Candidate applicants and all ROTC graduates:

In numerical sequence, indicate 10 branch preferences other than CA and SS.

USAR applicants: If applying for a specific Reserve vacancy, indicate

ONLY the

branch of the vacant position; all other applicants may enter more than one branch.

PERSONAL DATA

7. NAME (Last, first, middle)(Explain variations from birth certificate in Item

41)

8. GRADE

9a. SOCIAL SECURITY NUMBER

PREFER-

BRANCH

SPECIALTY

ENCE

10. BRANCH

11. TOTAL YRS

12. MARITAL

13. NUMBER OF DEPENDENTS UNDER 18

9b. SELECTIVE SERVICE NUMBER

(MOS if enl or wo)

ACTIVE SERVICE

STATUS

YEARS OF AGE

14. DATE OF

15. PLACE OF BIRTH (City, county,

16. SEX

17. COMPLETE MILITARY ADDRESS

(If presently on active duty) (Include ZIP

BIRTH

state)

Code)

PHONE AND/OR AUTOVON NUMBER

18. PERMANENT ADDRESS (Include ZIP Code)

19. CURRENT MAILING ADDRESS (If difference from Item 18) (Include ZIP Code)

PHONE (Include area code)

20. US

a. NATIVE

NATURALIZATION

c. APPLICANT'S CERTIFICATE NO. (If Item b. checked) (Date, place, court)

CITIZEN

YES

DERIVED

IMMIGRANT

21. CIVILIAN EDUCATION

(See page 3 for additional requirements for professional personnel)

a. HIGH SCHOOL GRADUATE

b. NAME AND LOCATION OF HIGH SCHOOL

YES

c. NAME AND LOCATION OF EACH COLLEGE

(2)

(3)

(4)

(5)

(1)

SEMESTER

DATE GRADUATED

OR UNIVERSITY ATTENDED (Include USMA,

YEARS

OR WILL GRADUATE

MAJOR

DEGREE

CREDITS

USNA, USAFA, USCGA, and USMMA)

ATTENDED

SUBJECT

EARNED

DAY

MONTH

YEAR

d. SPECIAL EDUCATIONAL HONORS, SCHOLAR-

e. IF YOU HAVE EVER BEEN EXPELLED FROM SCHOOL, OR PLACED ON PROBATION, EITHER FOR

SHIPS, ETC.

ACADEMIC OR DISCIPLINARY REASONS, EXPLAIN (Continue in Item 41(Remarks))

22.HIGHEST LEVEL SERVICE SCHOOL ATTENDED

23a. FOREIGN LANGUAGES AND DEGREE OF PROFICIENCY

b. ALAT SCORE (If applicable)

DA FORM 61, JUN 81

EDITION OF 1 AUG 74 AND DA FORM 61-R, 26 SEP 75, PRIVACY ACT STATEMENT, ARE OBSOLETE.

USAPPC V1.00

24. ARE YOU NOW, OR HAVE YOU EVER BEEN A CONSCIENTIOUS OBJECTOR?

YES

NO (If yes, attach affidavit)

25.

I UNDERSTAND THAT, IF I AM SELECTED FOR APPOINTMENT, I WILL BE EXPECTED TO ACCEPT SUCH ASSIGNMENTS AS ARE IN THE BEST INTEREST OF THE SERVICE

REGARDLESS OF MY MARITAL STATUS AND/OR RESPONSIBILITY FOR DEPENDENTS; AND IT IS MY RESPONSIBILITY TO MAKE APPROPRIATE ARRANGEMENTS FOR THE CARE OF MY

DEPENDENTS SHOULD I BE REQUIRED TO PERFORM DUTY IN AN AREA WHERE DEPENDENTS ARE NOT PERMITTED.

26. HAVE YOU EVER UNDER EITHER MILITARY OR CIVILIAN LAW BEEN INDICTED OR SUMMONED IN TO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING (Including any

proceedings involving juvenile offenses, article 15, UCMJ, and any court-martial)

REGARDLESS OF THE RESULT OF TRIAL, OR CONVICTED, FINED, IMPRISONED, PLACED ON

PROBATION, PAROLED OR PARDONED, OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR

ORDINANCE? (Exclude traffic violations involving a fine or forfeiture of $100 or less).

YES

NO IF YES, ATTACH REQUEST FOR WAIVER LISTING THE DATE, THE NATURE OF EACH ALLEGED OFFENSE OR VIOLATION, THE NAME AND LOCATION OF

THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER DISPOSITION OF EACH CASE AND FURNISH COPY OF COURT ACTION OR DETAILED STATEMENT IN

AFFIDAVIT FORM AS TO THE OUTCOME OF EACH CASE.

27.

ACTIVE MILITARY SERVICE

(Indicate tour with each organization separately - show ROTC Camps in Item 39)

a. ORGANIZATION

b. DATES

(Day, Month, Year)

c. BRANCH/MOS

d. PRIOR

e. HIGHEST GRADE

(US Armed Forces, USCG, NOAA,

SERVICE NO.

FROM

(As appropriate)

AND COMPONENT

US Public Health Service, Peace Corps)

(If applicable)

ENLISTED

WARRANT

OFFICER

COMMIS-

SIONED

f. DATE CURRENT ACTIVE DUTY TOUR TERMINATES

g. DATE OF LAST ADL PROMOTION

28.

RESERVE OR NATIONAL GUARD SERVICE (Not on active duty)

a. ORGANIZATION

b. DATES

(Day, Month, Year)

c. BRANCH/MOS

d. PRIOR

e. HIGHEST GRADE

(US Armed Forces, USCG, NOAA,

SERVICE NO.

FROM

(As appropriate)

AND COMPONENT

US Public Health Service, Peace Corps)

(If applicable)

ENLISTED

WARRANT

OFFICER

COMMIS-

SIONED

29. SOURCE OF CURRENT COMMISSION (If applicable)

OTHER

30. AWARDS (Do not list theater or service medals)

ARNGUS:

OCS

DIRECT APPOINTMENT

USAR:

ROTC

ROTC (ECP)

ROTC (SMP)

OCS

DIRECT APPOINTMENT

31. HAVE YOU EVER APPLIED AND NOT BEEN SELECTED FOR:

a. ROTC

YES

b. OCS

YES

c. APPOINTMENT IN RESERVE COMPONENT (USAR/ARNG)

YES

d. APPOINTMENT IN REGULAR ARMY

YES

AS A WARRANT OFFICER

AS A COMMISSIONED OFFICER

e. IF ANSWER IS "YES", EXPLAIN FULLY

32. ARE YOU NOW OR HAVE YOU EVER BEEN IN THE MILITARY SERVICE OF OR BEEN EMPLOYED BY A FOREIGN GOVERNMENT (If yes, give dates, country and type of service or

employment)

33. HAVE YOU EVER RESIGNED OR BEEN ASKED TO RESIGN IN LIEU OF ELIMINATION PROCEEDINGS; BEEN DISCHARGED IN LIEU OF ELIMINATION, FURLOUGHED

(other than

regular furlough or leave), OR PLACED ON INACTIVE STATUS WHILE SERVING IN THE US ARMED FORCES; OR, HAVE YOU EVER RESIGNED OR BEEN ASKED TO RESIGN FROM

A POSITION WHILE IN PRIVATE OR GOVERNMENT EMPLOYMENT? (If yes, state circumstances; if more space is required, continue on separate sheet).

YES

USAPPC V1.00

	34. APPLICANTS FOR JUDGE ADVOCATE GENERAL'S CORPS ONLY	35. APPLICANTS FOR
	34. APPLICANTS FOR JUDGE ADVOCATE GENERAL'S CORPS ONLY	CHAPLAINS BRANCH ONLY
		CHAPLAINS BRANCH ONLY

	BARS OF WHICH YOU ARE A MEMBER (Specify dates)	RELIGIOUS DENOMINATION BY
		WHICH YOU WILL BE ENDORSED

36.APPLICANTS FOR MEDICAL AND DENTAL CORPS ONLY

	a. TRAINING		c. DATES	(Month and Year)
		b. NAME AND LOCATION OF HOSPITAL
LEVEL	TYPE	b. NAME AND LOCATION OF HOSPITAL	FROM	TO
LEVEL	TYPE		FROM	TO

INTERNSHIP

RESIDENCY TNG

SPECIALTY TNG

d. SPECIALTY BOARDS

e. DATES OF CERTIFICATION (Day, Month, Yr)

f. PLACE IN WHICH CURRENTLY LICENSED

37.APPLICANTS FOR ARMY NURSE CORPS AND ARMY MEDICAL SPECIALIST CORPS ONLY

a. NAME OF NURSING OR ACCREDITED PROFESSIONAL SCHOOL	b. LOCATION

c. DATES OF ATTENDANCE (Mo, Yr)

FROM	TO

d. STATE AND CURRENT REGISTRATION NUMBER

e.STATE AND DATE OF INITIAL REGISTRATION (Day, Month, Year)

f. POSTGRADUATE COURSES (Include courses at general hospitals, service schools, and short courses)

(1)

SUBJECT OR COURSE

(2)

NAME AND LOCATION OF SCHOOL OR HOSPITAL

(3)SEMESTER

CREDITS EARNED

(4)DATES OF ATTENDANCE (Month, Year)

FROMTO

38.HAVE YOU BEEN EMPLOYED BY THE US ARMY AS A DIETITIAN, OCCUPATIONAL OR PHYSICAL THERAPIST? (If yes, give dates)

YES NO

39.ARMY ROTC (To be completed only by prospective ROTC graduates applying for appointment in USAR or RA)

SUCCESSFULLY COMPLETED AROTC PROGRAM AS FOLLOWS

	DATES ATTENDED (Month and Year)
COURSE				c. CAMP TRAINING
	FROM	TO

		(1)	INSTALLATION (Basic)	COMPLETION DATE (Month, Year)
a. BASIC

		(2)	INSTALLATION (Advanced/Ranger)	COMPLETION DATE (Month, Year)

b.ADVANCED

40.MAIN CIVILIAN EMPLOYMENT

a. NAME AND ADDRESS OF EMPLOYER	b. JOB TITLE		c. MONTH AND YEAR

		FROM		TO

b.PRINCIPAL DUTIES (Describe briefly)

41.REMARKS (Experience, proficiencies and special abilities not shown elsewhere in this application. Those required to enter primary entry specialties, see Para 1-27d,e, AR 601-100). (If more space is required, attach additional sheet)

42.THE INFORMATION CONTAINED HEREIN IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

DATE

SIGNATURE OF APPLICANT

USAPPC V1.00

	THIS PAGE NOT TO BE COMPLETED BY APPLICANT

PART I - RECOMMENDATION FOR APPOINTMENT OF ROTC GRADUATE AS A (REGULAR) OR
(RESERVE)	COMMISSIONED OFFICER OF THE ARMY (AR 601-100, AR 145-1) (To be completed by PMS only)

FROM: (Name and Address of Institution)		TO: (Appropriate Region Commander)

a.APPLICANT WILL HAVE SUCCESSFULLY COMPLETED AT THIS INSTITUTION THE PRESCRIBED COURSE FOR THE UNIT ON

b.	APPLICANT					(Date)
		HAS	HAS NOT COMPLETED SUCCESSFULLY THE REQUIRED CAMP TRAINING.
c.	APPLICANT	WILL HAVE ATTAINED		WILL NOT HAVE ATTAINED, A BACCALAUREATE DEGREE UPON SUCCESSFUL COMPLETION OF THE ROTC COURSE.
d.	I CONSIDER APPLICANT PHYSICALLY, MENTALLY, MORALLY, AND PROFESSIONALLY QUALIFIED FOR APPOINTMENT AS A				REGULAR	RESERVE COMMISSIONED
	OFFICER OF THE ARMY RECOMMEND HIS APPOINTMENT.

e. APPLICANT WILL ATTAIN FULL QUALIFICATION FOR, AND SHOULD BE APPOINTED ON

(Day, Month and Year)

DATE

BRANCH FOR ASSIGNMENT

SIGNATURE AND GRADE (PMS)

PART II - RECOMMENDATION FOR APPLICANTS FOR OCS ONLY (AR 351-5)

a. STATEMENT

TO:						DATE

1.	I HAVE KNOWN THE APPLICANT FOR			MONTHS. HE HAS SERVED UNDER ME FOR	MONTHS. HIS PRINCIPAL DUTY IS

2.	I	DO	DO NOT RECOMMEND THE APPLICANT.
3.	REMARKS (Include your opinion as to his/her overall ability (to include leadership) and value to the service).

ENCLOSURES

ORGANIZATION

b.STATEMENT TO:

SIGNATURE

TYPED NAME, GRADE AND TITLE

DATE

1.	I HAVE KNOWN THE APPLICANT FOR			MONTHS. HE HAS SERVED UNDER ME FOR	MONTHS. HIS PRINCIPAL DUTY IS

2.	I	DO	DO NOT RECOMMEND THE APPLICANT.
3.	REMARKS (Include your opinion as to his/her overall ability (to include leadership) and value to the service).

ENCLOSURES

ORGANIZATION

SIGNATURE

TYPED NAME, GRADE AND TITLE

USAPPC V1.00

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3. Within this step, have a look at a FOREIGN LANGUAGES AND DEGREE OF, b ALAT SCORE If applicable, DA FORM JUN, EDITION OF AUG AND DA FORM R, and USAPPC V. These should be filled out with greatest focus on detail.

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c. DATES (Mo-Yr)

a. NAME OF SCHOOL

d. IF NOT COMPLETED GIVE REASON