The Department of the Army form 7223, also known as the "Statement of Service," is a document used to verify military service for benefits or other purposes. The form can be used to prove service dates, rank, and character of service. The statement of service is an important document for veterans seeking benefits from the Department of Veterans Affairs (VA) or other agencies. The form can also be used to establish proof of military service for school admissions or employment with the federal government. Generally, the form must be notarized and submitted with copies of supporting documentation such as orders, certificates, and awards. The Department of Defense (DoD) provides an online tool called milconnect to help veterans create a digital Statement of Service. The tool
| Question | Answer |
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| Form Name | Da Form 7223 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | da form 7223, da 7223, da7223, civilian evaluation pdf |
BASE SYSTEM CIVILIAN EVALUATION REPORT
For use of this form, see AR
PART I - ADMINISTRATIVE DATA
a. NAME (Last, First, Middle Initial) |
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b. POSITION TITLE, PAY PLAN, SERIES AND GRADE |
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c. ORGANIZATION/INSTALLATION |
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d. REASON FOR SUBMISSION |
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ANNUAL |
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SPECIAL |
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e. PERIOD COVERED (YYYYMMDD) |
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f. RATED MOS. |
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g. RATEE COPY (Check one and date) |
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FROM |
THRU |
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GIVEN TO RATEE |
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FORWARDED TO RATEE |
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PART II - AUTHENTICATION |
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a. NAME OF RATER (Last, First, Middle Initial) |
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SIGNATURE |
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DATE (YYYYMMDD) |
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GRADE/RANK, ORGANIZATION, DUTY ASSIGNMENT |
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b. NAME OF INTERMEDIATE RATER (Optional)(Last, First, MI) |
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SIGNATURE |
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DATE (YYYYMMDD) |
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GRADE/RANK, ORGANIZATION, DUTY ASSIGNMENT |
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c. NAME OF SENIOR RATER (Last, First, Middle Initial) (If used) |
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SIGNATURE |
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DATE (YYYYMMDD) |
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GRADE/RANK, ORGANIZATION, DUTY ASSIGNMENT |
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d. RATEE: I understand my signature does not constitute |
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SIGNATURE OF RATEE |
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DATE (YYYYMMDD) |
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agreement or disagreement with the evaluations of the Rater |
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and Senior Rater, and merely verifies Part I and Part IV data. |
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PART III - PERFORMANCE AWARD/QUALITY STEP INCREASE |
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PERCENT OF SALARY( INCLUDES Locality Pay) |
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% (OR) |
AWARD APPROVED BY |
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AMOUNT $ |
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(OR) |
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QSI (GS with Successful Level 1 Rating Only - minimum of 52 weeks |
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DATE (YYYYMMDD) |
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FUND CITE |
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must have elapsed since last QSI) |
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TO (Grade/Step) |
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PART IV - DUTY DESCRIPTION (Rater) |
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a. DAILY DUTIES AND SCOPE (To include as appropriate: people, equipment, facilities, and dollars) . Position Description is correct: |
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YES |
NO |
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b. AREAS OF SPECIAL EMPHASIS |
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c. |
COUNSELING DATES FROM |
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INITIAL |
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LATER (Optional) |
MIDPOINT |
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LATER (Optional) |
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CHECKLIST/RECORD |
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PART V - VALUES (Rater) |
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VALUES |
BULLET COMMENTS |
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Loyalty |
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Duty |
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Respect |
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Selfless service |
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Honor |
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Integrity |
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Personal courage |
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DA FORM 7223, MAR 2010 |
PREVIOUS EDITIONS ARE OBSOLETE. |
APD LC v1.00ES |
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RATEE'S NAME (Last, First, Middle Initial) |
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THRU DATE |
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b. RESPONSIBILITIES |
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Specific bullet examples of other than "SUCCESS," are mandatory. |
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Specific bullet examples of "SUCCESS" are optional but encouraged. |
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1. TECHNICAL COMPETENCE |
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Technical knowledges, skills, abilities |
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Doing work right/on time |
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Sound judgement |
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EXCELLENCE |
SUCCESS |
NEEDS |
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FAILS |
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(Exceeds std) |
(Meets std) |
IMPROVEMENT |
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2. ADAPTABILITY AND INITIATIVE |
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Adjusting to change - situations/people |
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Trying new things |
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Seeking |
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EXCELLENCE |
SUCCESS |
NEEDS |
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FAILS |
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(Exceeds std) |
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IMPROVEMENT |
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3. WORKING RELATIONSHIPS & COMMUNICATIONS |
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Supporting team |
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Respecting others |
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Expressing ideas clearly |
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Listening/understanding |
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EXCELLENCE |
SUCCESS |
NEEDS |
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FAILS |
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IMPROVEMENT |
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4. RESPONSIBILITY AND DEPENDABILITY |
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Dependable/reliable |
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Maintaining facilities/equipment |
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Conserving supplies/time |
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People/equipment safety |
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EXCELLENCE |
SUCCESS |
NEEDS |
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FAILS |
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IMPROVEMENT |
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Numbers 5 and 6 apply to positions with some supervisory duties |
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5. SUPERVISION AND LEADERSHIP |
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Mission focused/performance oriented |
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Sets standard/Leads by example |
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Motivating/developing others |
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Implementing DA emphasis programs/managing |
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resources |
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EXCELLENCE |
SUCCESS |
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IMPROVEMENT |
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6. EEO AND AFFIRMATIVE ACTION |
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Respecting dignity |
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Achieving planned actions |
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Providing opportunity |
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Solving problems |
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EXCELLENCE |
SUCCESS |
NEEDS |
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FAILS |
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IMPROVEMENT |
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PART VI |
or |
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PART VII - SENIOR RATER (If used) |
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RATER (no senior rater used) |
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OVERALL PERFORMANCE |
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BULLET COMMENTS (Performance/Potential) |
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SUCCESSFUL FAIR UNSUCCESSFUL
(MUST Have Senior
Rater Review)
A completed DA Form
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YES |
NO (Explain) |
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REVERSE, DA FORM 7223, MAR 2010
APD LC v1.00ES