Da Form 67 9 – Fill Out and Use This PDF

OFFICER EVALUATION REPORT

FOR OFFICIAL USE ONLY (FOUO)

For use of this form, see AR 623-3; the proponent agency is DCS, G-1.

SEE PRIVACY ACT STATEMENT IN AR 623-3.

PART I - ADMINISTRATIVE DATA

a. NAME (Last, First, Middle Initial)

b. SSN

c. RANK

d. DATE OF RANK (YYYYMMDD)

e. BRANCH

f. SPECIALTIESDESIGNATED / PMOS (W0)

g.1. UNIT, ORG., STATION, ZIP CODE OR APO, MAJOR COMMAND

g.2. STATUS CODE

h. REASON FOR SUBMISSION

i. PERIOD COVERED

j. RATED

k. NONRATED

l. NO. OF

m. RATED OFFICER'S AKO EMAIL ADDRESS

n. UIC

o. CMD

p. PSB

FROM (YYYYMMDD)

THRU (YYYYMMDD)

MONTHS

CODES

ENCL

(.gov or mil)

CODE

CODE

PART II - AUTHENTICATION (Rated officer's signature verifies officer has seen completed OER Parts I-VII and the admin data is correct)

a. NAME OF RATER (Last, First, MI)

SSN

RANK

POSITION

SIGNATURE

DATE (YYYYMMDD)

b. NAME OF INTERMEDIATE RATER (Last, First, MI)

SSN

RANK

POSITION

SIGNATURE

DATE (YYYYMMDD)

c. NAME OF SENIOR RATER (Last, First, MI)

SSN

RANK

POSITION

SIGNATURE

DATE (YYYYMMDD)

SENIOR RATER'S ORGANIZATION

BRANCH

SENIOR RATER TELEPHONE NUMBER

E-MAIL ADDRESS (.gov or .mil)

d. This is a referred report, do you wish to make comments?

e. SIGNATURE OF RATED OFFICER

DATE (YYYYMMDD)

Yes, comments are attached

No

PART III - DUTY DESCRIPTION

a. PRINCIPAL DUTY TITLE

b. POSITION AOC/BR

c. SIGNIFICANT DUTIES AND RESPONSIBILITIES. REFER TO PART IVa, DA FORM 67-9-1.

PART IV - PERFORMANCE EVALUATION - PROFESSIONALISM (Rater)

CHARACTER Disposition of the leader: combination of values, attributes, and skills affecting leader actions

a. ARMY VALUES (Comments mandatory for all "NO" entries. Use PART Vb.)

Yes

No

Yes No

1. HONOR: Adherence to the Army's publicly declared code of values

5. RESPECT: Promotes dignity, consideration, fairness, & EO

2. INTEGRITY:Possesses high personal moral standards; honest in word and deed

6. SELFLESS-SERVICE: Places Army priorities before self

3. COURAGE: Manifests physical and moral bravery

7. DUTY: Fulfills professional, legal, and moral obligations

4. LOYALTY: Bears true faith and allegiance to the U.S. Constitution, the Army, the unit, and the soldier

b. LEADER ATTRIBUTES / SKILLS / ACTIONS: First, mark "YES" or "NO" for each block. Second, choose a total of six that best describe the rated officer. Select one from

ATTRIBUTES, two from SKILLS (Competence), and three from ACTIONS (LEADERSHIP). Place an "X" in the appropriate numbered box with optional comments in PART Vb.

Comments are mandatory in Part Vb for all "No" entries.

b.1. ATTRIBUTES (Select 1)

1. MENTAL

2 .

PHYSICAL

3. EMOTIONAL

Fundamental qualities and

Possesses desire, will, initiative, and discipline

Maintains appropriate level of physical

Displays self-control; calm under pressure

characteristics

fitness and military bearing

b.2 SKILLS (Competence)

1. CONCEPTUAL

2.

INTERPERSONAL

3. TECHNICAL

(Select 2)

Demonstrates sound judgment, critical/creative

Shows skill with people: coaching, teaching,

Possesses the necessary expertise to

Skill development is part of self-

thinking, moral reasoning

counseling, motivating and empowering

accomplish all tasks and functions

development; prerequisite to action

4. TACTICAL Demonstrates proficiency in required professional knowledge, judgment, and warfighting

b.3. ACTIONS (LEADERSHIP) (Select 3) Major activities leaders perform: influencing, operating, and improving

INFLUENCING

1. COMMUNICATING

2. DECISION-MAKING

3. MOTIVATING

Method of reaching goals while

Displays good oral, written, and listening skills for

Employs sound judgment, logical reasoning

Inspires, motivates, and guides others toward

operating / improving

individuals / groups

and uses resources wisely

mission accomplishment

OPERATING

4. PLANNING

5.

EXECUTING

6. ASSESSING

Short-term mission

Develops detailed, executable plans that are

Shows tactical proficiency, meets mission

Uses after-action and evaluation tools to

accomplishment

feasible, acceptable, and suitable

standards, and takes care of people/resources

facilitate consistent improvement

IMPROVING

7. DEVELOPING

8.

BUILDING

9. LEARNING

Long-term improvement in the Army

Invests adequate time and effort

to

develop

Spends time and resources improving teams,

Seeks self-improvement and

organizational

its people and organizations

individual subordinates as leaders

groups and units; fosters ethical climate

growth; envisioning, adapting and leading change

c. APFT:

DATE:

HEIGHT:

WEIGHT:

NAME

SSN

PERIOD COVERED