Dd Form 4 1 PDF Details

Dd Form 4 1 is a government form used to document the medical and dental history of service members. The form can be used to track current and past medical conditions, allergies, medications, and dental health. The form must be completed by a service member's healthcare provider and submitted with the member's military personnel records. Completing the Dd Form 4 1 is important for ensuring that service members receive the best possible care while serving in the military. The Dd Form 4 1 is also known as DD2900 in some circles; it was formerly called just "Form 2900". This blog post will go over what information is required on the form, who needs to fill it out, and why it's so important. Read on to

QuestionAnswer
Form NameDd Form 4 1
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesdd form 4 fillable, dd4 form, where can i find my dd form 4 1, dd form 4

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(list date (YYYYMMDD))
(list name of Annex(es) and describe)

ENLISTMENT/REENLISTMENT DOCUMENT

ARMED FORCES OF THE UNITED STATES

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. 3331; 10 U.S.C. 113, 136, 502, 504, 505, 506, 507, 508, 509, 510, 513, 515, 516, 518, 519, 972, 978, 2107, 2107a, 3253, 3258, 3262, 5540, 8252, 8253, 8257, 8258, 12102, 12103, 12104, 12105, 12106, 12107, 12108, 12301, 12302, 12304, 12305, 12405; 14 USC 351, 632; 32 U.S.C. 301, 302, 303, 304; and Executive Order 9397, November 1943 (SSN).

PRINCIPAL PURPOSE(S): To record enlistment or reenlistment into the U.S. Armed Forces. This information becomes a part of the subject's military personnel records which are used to document promotion, reassignment, training, medical support, and other personnel management actions. The purpose of soliciting the SSN is for positive identification.

ROUTINE USE(S): This form becomes a part of the Service's Enlisted Master File and Field Personnel File. All uses of the form are internal to the relevant Service.

DISCLOSURE: Voluntary; however, failure to furnish personal identification information may negate the enlistment/reenlistment application.

A. ENLISTEE/REENLISTEE IDENTIFICATION DATA

1.

NAME (Last, First, Middle)

 

2.

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

3.

HOME OF RECORD (Street, City, State, ZIP Code)

4.

PLACE OF ENLISTMENT/REENLISTMENT (Mil. Installation, City, State)

 

 

 

 

 

 

 

 

5.

DATE OF ENLISTMENT/

6. DATE OF BIRTH (YYYYMMDD)

7.

PREV MIL SVC UPON ENL/REENLIST

YEARS

MONTHS

DAYS

 

REENLISTMENT (YYYYMMDD)

 

 

 

 

 

 

 

 

a. TOTAL ACTIVE MILITARY SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. TOTAL INACTIVE MILITARY SERVICE

 

 

 

B.AGREEMENTS

8.I am enlisting/reenlisting in the United States (list branch of service)

this date for

 

 

 

years and

 

 

weeks beginning in pay grade

 

 

of which

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

years and

 

weeks is considered an Active Duty Obligation, and

 

years and

 

 

 

 

 

 

 

 

 

 

 

weeks will be served in the Reserve Component of the Service in which I have enlisted. If this is an initial

enlistment, I must serve a total of eight (8) years, unless I am sooner discharged or otherwise extended by the appropriate authority. This eight year service requirement is called the Military Service Obligation. The additional details of my enlistment/ reenlistment are in Section C and Annex(es)

a. FOR ENLISTMENT IN A DELAYED ENTRY/ENLISTMENT PROGRAM (DEP):

I understand that I am joining the DEP. I understand that by joining the DEP I am enlisting in the Ready Reserve component of the

United States (list branch of service)for a period not to exceed

365 days, unless this period of time is otherwise extended by the Secretary concerned. While in the DEP, I understand that I am in a nonpay status and that I am not entitled to any benefits or privileges as a member of the Ready Reserve, to include, but not limited to medical care, liability insurance, death benefits, education benefits, or disability retired pay if I incur a physical disability. I understand that the period of time while I am in the DEP is NOT creditable for pay purposes upon entry into a pay status. However, I also understand that the period of time while I am in the DEP is counted toward fulfillment of my military service obligation described in paragraph 10, below. While in the DEP, I understand that I must maintain my current qualifications and keep my recruiter informed of any changes in my physical or dependency status, qualifications, and mailing address. I understand that I WILL be ordered to active duty unless I report to the place shown in item 4 above by

for enlistment in the Regular component of the United States (list branch of service)

for not less than

 

years and

 

weeks.

 

 

 

 

 

b.REMARKS: (lf none, so state.)

c.The agreements in this section and attached annex(es) are all the promises made to me by the Government. ANYTHING ELSE

ANYONE HAS PROMISED ME IS NOT VALID AND WILL NOT BE HONORED.

(Initials of Enlistee/Reenlistee)

 

 

(Continued on Page 2)

 

 

 

 

 

 

 

DD FORM 4/1, JUL 2007

 

PREVIOUS EDITION IS OBSOLETE.

Adobe Professional 7.0

C. PARTIAL STATEMENT OF EXISTING UNITED STATES LAWS

9.FOR ALL ENLISTEES OR REENLISTEES:

I understand that many laws, regulations, and military customs

will govern my conduct and require me to do things under this agreement that a civilian does not have to do. I also understand that various laws, some of which are listed in this agreement, directly affect this enlistment/reenlistment agreement. Some examples of how existing laws may affect this agreement are explained in paragraphs 10 and 11. I understand that I cannot change these laws but that Congress may change these laws, or pass new laws, at any time that may affect this agreement, and that I will be subject to those laws and any changes they make to this agreement. I further understand that:

a. My enlistment/reenlistment agreement is more than an employment agreement. It effects a change in status from civilian to military member of the Armed Forces. As a member of the Armed Forces of the United States, I will be:

(1)Required to obey all lawful orders and perform all assigned

duties.

(2)Subject to separation during or at the end of my enlistment. If my behavior fails to meet acceptable military standards, I may be discharged and given a certificate for less than honorable service, which may hurt my future job opportunities and my claim for veteran's benefits.

(3)Subject to the military justice system, which means, among other things, that I may be tried by military courts-martial.

(4)Required upon order to serve in combat or other hazardous situations.

(5)Entitled to receive pay, allowances, and other benefits as provided by law and regulation.

b. Laws and regulations that govern military personnel may change without notice to me. Such changes may affect my status, pay, allowances, benefits, and responsibilities as a member of the Armed Forces REGARDLESS of the provisions of this enlistment/ reenlistment document.

10.MILITARY SERVICE OBLIGATION, SERVICE ON ACTIVE DUTY AND STOP-LOSS FOR ALL MEMBERS OF THE ACTIVE AND RESERVE COMPONENTS, INCLUDING THE NATIONAL GUARD.

a.FOR ALL ENLISTEES: If this is my initial enlistment, I must serve a total of eight (8) years, unless I am sooner discharged or otherwise extended by the appropriate authority. This eight year service requirement is called the Military Service Obligation. Any part of that service not served on active duty must be served in the Reserve Component of the service in which I have enlisted. If this is a reenlistment, I must serve the number of years specified in this agreement, unless I am sooner discharged or otherwise extended by the appropriate authority. Some laws that affect when I may be ordered to serve on active duty, the length of my service on active duty, and the length of my service in the Reserve Component, even beyond the eight years of my Military Service Obligation, are discussed in the following paragraphs.

b.I understand that I can be ordered to active duty at any time while I am a member of the DEP. In a time of war, my enlistment may be extended without my consent for the duration of the war and for six months after its end (10 U.S.C. 506, 12103(c)).

c.As a member of a Reserve Component of an Armed Force, in time of war or of national emergency declared by the Congress, I may, without my consent, be ordered to serve on active duty, for the entire period of the war or emergency and for six (6) months after its end (10 U.S.C. 12301(a)). My enlistment may be extended during this period without my consent (10 U.S.C. 12103(c)).

d.As a member of the Ready Reserve (to include Delayed Entry Program), in time of national emergency declared by the President, I may, without my consent, be ordered to serve on active duty, and my military service may be extended without my consent, for not more than 24 consecutive months (10 U.S.C. 12302). My enlistment may be extended during this period without my consent (see paragraph 10g).

e.As a member of the Ready Reserve, I may, at any time and without my consent, be ordered to active duty to complete a total of 24 months of active duty, and my enlistment may be extended so I can complete the total of 24 months of active duty, if:

(1)I am not assigned to, or participating unsatisfactorily in, a unit of the Ready Reserve; and

(2)I have not met my Reserve obligation; and

(3)I have not served on active duty for a total of 24 months (10 U.S.C. 12303).

f.As a member of the Selected Reserve or as a member of the Individual Ready Reserve mobilization category, when the President determines that it is necessary to augment the active forces for any operational mission or for certain emergencies, I may, without my consent, be ordered to active duty for not more than 270 days (10 U.S.C. 12304). My enlistment may be extended during this period without my consent (see paragraph 10g).

g.During any period members of a Reserve component are serving on active duty pursuant to an order to active duty under authority of 10 U.S.C. 12301, 12302, or 12304, the President may suspend any provision of law relating to my promotion, retirement, or separation from the Armed Forces if he or his designee determines I am essential to the national security of the United States. Such an action may result in an extension, without my consent, of the length of service specified in this agreement. Such an extension is often called a "stop-loss" extension (10 U.S.C. 12305).

h.I may, without my consent, be ordered to perform additional active duty training for not more than 45 days if I have not fulfilled my military service obligation and fail in any year to perform the required training duty satisfactorily. If the failure occurs during the last year of my required membership in the Ready Reserves, my enlistment may be extended until I perform that additional duty, but not for more than six months (10 U.S.C. 10148).

11.FOR ENLISTEES/REENLISTEES IN THE NAVY, MARINE CORPS, OR COAST GUARD: I understand that if I am serving on a naval vessel in foreign waters, and my enlistment expires, I will be returned to the United States for discharge as soon as possible consistent with my desires. However, if essential to the public interest, I understand that I may be retained on active duty until the vessel returns to the United States. If I am retained under these circumstances, I understand I will be discharged not later than 30 days after my return to the United States; and, that except in time of war, I will be entitled to an increase in basic pay of 25 percent from the date my enlistment expires to the date of my discharge.

12.FOR ALL MALE APPLICANTS: Completion of this form constitutes registration with the Selective Service System in accordance with the Military Selective Service Act. Incident thereto the Department of Defense may transmit my name, permanent address, military address, Social Security Number, and birthdate to the Selective Service System for recording as evidence of the registration.

(Initials of Enlistee/Reenlistee)

DD FORM 4/1 (PAGE 2), JUL 2007

NAME OF ENLISTEE/REENLISTEE (Last, First, Middle)

SOCIAL SECURITY NO. OF ENLISTEE/REENLISTEE

 

 

D. CERTIFICATION AND ACCEPTANCE

13a. My acceptance for enlistment is based on the information I have given in my application for enlistment. If any of that information is false or incorrect, this enlistment may be voided or terminated administratively by the Government or I may be tried by a Federal, civilian, or military court and, if found guilty, may be punished.

I certify that I have carefully read this document, including the partial statement of existing United States laws in Section C and how they may affect this agreement. Any questions I had were explained to my satisfaction. I fully understand that only those agreements in Section B and Section C of this document or recorded on the attached annex(es) will be honored. I also understand that any other promises or guarantees made to me by anyone that are not set forth in Section B or the attached annex(es) are not effective and will not be honored.

b. SIGNATURE OF ENLISTEE/REENLISTEE

c. DATE SIGNED (YYYYMMDD)

 

 

14. SERVICE REPRESENTATIVE CERTIFICATION

 

a. On behalf of the United States (list branch of service)

,

I accept this applicant for enlistment. I have witnessed the signature in item 13b to this document. I certify that I have explained that only those agreements in Section B of this form and in the attached Annex(es) will be honored, and any other promises made by any person are not effective and will not be honored.

b. NAME (Last, First, Middle)

c. PAY GRADE

d. UNIT/COMMAND NAME

 

 

 

e. SIGNATURE

f. DATE SIGNED

g. UNIT/COMMAND ADDRESS (City, State, ZIP Code)

 

(YYYYMMDD)

 

 

 

 

 

E. CONFIRMATION OF ENLISTMENT OR REENLISTMENT

 

 

15. IN THE ARMED FORCES EXCEPT THE NATIONAL GUARD (ARMY OR AIR):

I,

 

, do solemnly swear (or affirm) that I will support and defend

the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to regulations and the Uniform Code of Military Justice. So help me God.

16. IN THE NATIONAL GUARD (ARMY OR AIR):

 

 

I,

 

, do solemnly swear (or affirm) that I will support and defend

the Constitution of the United States and the State of

 

 

against all enemies, foreign and

domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of the President of the United States

and the Governor of

 

 

and the orders of the officers appointed over me, according to law

 

and regulations. So help me God.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17. IN THE NATIONAL GUARD (ARMY OR AIR):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I do hereby acknowledge to have voluntarily enlisted/reenlisted this

 

 

 

 

day of

 

 

,

 

 

in the

National Guard and as a Reserve of the United States (list branch of service)

 

 

 

 

 

 

 

 

 

 

 

 

 

with membership in the

 

 

 

 

 

National Guard of the United States for a period of

 

 

 

years,

 

 

 

months,

 

days, under the

 

conditions prescribed by law, unless sooner discharged by proper authority.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.a. SIGNATURE OF ENLISTEE/REENLISTEE

 

 

 

 

 

 

b. DATE SIGNED (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19. ENLISTMENT/REENLISTMENT OFFICER CERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

a. The above oath was administered, subscribed, and duly sworn to (or affirmed) before me this date.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. NAME (Last, First, Middle)

c. PAY GRADE

 

d. UNIT/COMMAND NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

e. SIGNATURE

f. DATE SIGNED

 

g. UNIT/COMMAND ADDRESS (City, State, ZIP Code)

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Initials of Enlistee/Reenlistee)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD FORM 4/2, JUL 2007

PREVIOUS EDITION IS OBSOLETE.

NAME OF ENLISTEE/REENLISTEE (Last, First, Middle)

SOCIAL SECURITY NO. OF ENLISTEE/REENLISTEE

 

 

F. DISCHARGE FROM/DELAYED ENTRY/ENLISTMENT PROGRAM

20a. I request to be discharged from the Delayed Entry/Enlistment Program (DEP) and enlisted in the Regular Component of the

United States (list branch of service)

 

 

for a period of

 

years and

 

 

 

weeks. No changes have been made to my enlistment options OR if changes were made they are recorded on

 

Annex(es)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

which replace(s) Annex(es)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

b. SIGNATURE OF DELAYED ENTRY/ENLISTMENT PROGRAM ENLISTEE

c. DATE SIGNED (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. APPROVAL AND ACCEPTANCE BY SERVICE REPRESENTATIVE

21. SERVICE REPRESENTATIVE CERTIFICATION

 

 

 

 

 

a. This enlistee is discharged from the Reserve Component shown in item 8 and is accepted for enlistment in the Regular

 

Component of the United States (list branch of service)

 

 

in pay grade

 

.

 

 

 

 

b. NAME (Last, First, Middle)

c. PAY GRADE

d. UNIT/COMMAND NAME

 

 

 

 

 

e. SIGNATURE

f. DATE SIGNED

g. UNIT/COMMAND ADDRESS (City, State, ZIP Code)

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

H. CONFIRMATION OF ENLISTMENT OR REENLISTMENT

 

 

22a. IN A REGULAR COMPONENT OF THE ARMED FORCES:

I,

 

, do solemnly swear (or affirm) that I will support and defend

the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same;

and that I will obey the orders of the President of the United States and the orders of the officers appointed over me, according to

regulations and the Uniform Code of Military Justice. So help me God.

b. SIGNATURE OF ENLISTEE/REENLISTEE

b. DATE SIGNED (YYYYMMDD)

 

 

23. ENLISTMENT OFFICER CERTIFICATION

a. The above oath was administered, subscribed, and duly sworn to (or affirmed) before me this date.

b. NAME (Last, First, Middle)

c. PAY GRADE

d. UNIT/COMMAND NAME

 

 

 

 

 

e. SIGNATURE

f. DATE SIGNED

g. UNIT/COMMAND ADDRESS (City, State, ZIP Code)

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

(Initials of Enlistee/Reenlistee)

 

 

 

 

 

 

 

DD FORM 4/3, JUL 2007

PREVIOUS EDITION IS OBSOLETE.

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A way to fill in enlisted form stage 1

2. Once your current task is complete, take the next step – fill out all of these fields - I understand that I am joining the, United States list branch of, for a period not to exceed, days unless this period of time, am not entitled to any benefits or, education benefits or disability, purposes upon entry into a pay, service obligation described in, informed of any changes in my, to active duty unless I report to, for enlistment in the Regular, of the United States list branch, for not less than, years, and months and with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Part no. 2 of submitting enlisted form

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enlisted form writing process outlined (stage 3)

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Part number 4 in filling out enlisted form

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5. Finally, this final part is precisely what you will need to finish prior to finalizing the document. The blanks in question include the next: NAME OF ENLISTEEREENLISTEE Last, SOCIAL SECURITY NUMBER Use for new, DoD ID NUMBER Use for reenlistments, D CERTIFICATION AND ACCEPTANCE, a My acceptance for enlistment is, enlistment may be voided or, punished, I certify that I have carefully, this agreement Any questions I had, this document or recorded on the, anyone that are not set forth in, b SIGNATURE OF ENLISTEEREENLISTEE, c DATE SIGNED YYYYMMDD, SERVICE REPRESENTATIVE, and a On behalf of the United States.

Part # 5 for filling in enlisted form

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