Form Navpers 1001 3 PDF Details

The Navpers 1001/3 form serves as a pivotal document for members of the Navy Ready Reserve, encapsulating a broad spectrum of personal and professional information critical for assessing readiness for mobilization. Instituted under the guidelines of BUPERSINST 1001.39, this form encompasses a Privacy Act Statement that highlights the authority and purpose behind the collection of such data, chiefly aimed at streamlining the management, supervision, and administration of Navy personnel. The form is designed to be comprehensive, covering aspects from current emergency data and dependent status to physical readiness and legal matters that could impact one's ability to be mobilized. By inquiring about essential details such as employment, key employee status, involvement in educational or religious programs, and any potential legal issues, the form ensures that the Navy officials have a thorough understanding of factors that might affect a reservist's mobilization readiness. Furthermore, it emphasizes the voluntary nature of disclosure, albeit warning of possible administrative or reserve status changes should the requested information not be provided. The completion and endorsement of the Navpers 1001/3 form, hence, play a crucial role in affirming a service member's mobilization readiness, reflecting a systematic approach to reserve management and the proactive identification of any issues that may delay or prevent their prompt deployment.

QuestionAnswer
Form NameForm Navpers 1001 3
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesready reserve screening, 1001 questionnaire, irr annual screening, navpers 1080 3 pdf

Form Preview Example

FILLABLE FORM

READY RESERVE SCREENING QUESTIONNAIRE

SUPPORTING DIRECTIVE BUPERSINST 1001.39

PRIVACY ACT STATEMENT

AUTHORITY AND PURPOSE: 5 U.S.C. 301, Departmental Regulations; and E.O. 9397 (SSN). Provided information is used to assist officials and employees of the Navy in the management, supervision and administration of Navy personnel (officer and enlisted) and the operations of related personnel affairs and functions.

ROUTING USES: Information will be utilized by Department of the Navy officials in verifying qualifications and suitability for continued assignment to the Ready Reserve.

DISCLOSURE: VOLUNTARY. However, failure to provide the requested information may result in an administrative change to your reserve status or separation from the Naval Reserve.

NAME: (Last, First, MI)

SSN(LAST 4 DIGITS):

PAYGRADE:

 

DESIG/RATE:

 

Place an “X” in the Yes or Nor box. Provide

amplifying information as required.

 

YES

NO

1.

Is your Record of Emergency Data (NAVPERS 1070/602) current?

If not, review and

 

 

update as necessary.

 

 

 

 

 

 

2.

Do you have a dependent(s) who would prevent, restrict or delay your mobilization?

 

If yes, explain. See note 1 BUPERSINST 1001.39 (Ch. 21).

 

 

 

 

 

 

 

 

 

 

3.

Do you have a spouse who is an active or reserve service member? If yes, see

 

 

 

notes 1 and 2 in BUPERSINST 1001.39 (Ch, 21).

 

 

 

 

 

 

4.

Are you a single member with dependent(s)?

If yes, see notes 1 and 2 in

 

 

 

BUPERSINST 1001.39 (Ch. 21)

 

 

 

 

 

 

5.

Have you within the last year failed to meet, or do you believe you are now unable

 

to meet, the physical readiness standards per OPNAVINST 6110.1? If yes, explain

 

 

 

below. See note 3 in BUPERSINST 1001.39 (Ch. 21).

 

 

 

 

 

 

 

 

 

 

6.

Do you have a medical problem or physical defect, which might prevent your

 

 

 

mobilization or restrict your assignment? If yes, explain below. See note 4 in

 

 

 

BUPERSINST 1001.39 (Ch. 21).

 

 

 

 

 

 

 

 

 

7.

Are you preparing for religious ministry by attending a recognized theological or

 

divinity school, or an equivalent, or preparing to meet religious faith group

 

 

 

requirements? If yes, identify institution course of instruction and date entered

 

program below. See note 5 in BUPERSINST 1001.39 (Ch. 21).

 

 

 

 

 

8.Are you a student, resident, or intern in any educational program, which leads to a certification as a medical doctor or dentist? If yes, describe program, credential to be awarded, date started and expected duration of course. See note 6 in BUPERSINST 1001.39 (Ch. 21).

NAVPERS 1001/3 (Rev. 05-04)

S/N: 0106-LF-130-6300

FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE

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SUPPORTING DIRECTIVE BUPESINST 1001.39

 

READY RESERVE SCREENING QUESTIONNAIRE (CONTINUED)

 

YES

NO

 

9(a). Are you currently employed? If yes, provide the information requested below.

 

 

 

 

Name of Organization:

Position Title:

 

 

 

 

9(b). Are you considered a “key” employee? If yes, please provide the information

 

 

 

 

 

 

 

 

listed below. See note 1 in BUPERSINST 1001.39 (Ch. 21).

 

 

 

 

POC:

Phone:

 

 

 

10.Do you have any benefits that would prevent or restrict your service during mobilization or recall? If yes, explain below. See note 1 in BUPERSINST 1001.39 (Ch. 21).

11.Are you a non-prior service member who has not completed a 12 week period of basic training or its equivalent? If yes, describe the circumstances. See note 7 in BUPERSINST 1001.39 (Ch. 21).

12.Do you know of any reason why your recall to active duty would create a personal or community hardship? If yes, explain below. See note 1 in BUPERSINST 1001.39 (Ch. 21).

13.Have you been convicted of any criminal offense? If yes, identify the offense below. See note 1 in BUPERSINST 1001.39 (Ch. 21)

14.Are you currently involved in any pending civil or criminal legal matters that could delay or preclude your immediate mobilization? See note 1 in BUPERSINST 1001.39 (Ch. 21)

15.Have you ever been convicted of a domestic violence offense? See notes 1 and 8 in BUPERSINST 1001.39 (Ch. 21).

16.Is there any other reason why you would not be immediately available for recall to active duty? If yes, explain. See note 1 in BUPERSINST 1001.39 (Ch. 21).

CERTIFICATION BY PERSON COMPLETING FORM

I

certify that the information

I have provided is

complete and accurate to the best of my knowledge.

I

will expeditiously notify my

commanding officer

of any circumstances that may develop in the future

that could delay or prevent my

immediate mobilization.

MEMBER’S SIGNATURE:

 

 

DATE:

 

 

 

 

 

COMMANDING OFFICER’S ENDORSEMENT (SELRES AND VTU ONLY)

I consider the member mobilization ready. I will notify the local Naval Reserve activity of any changes to the member’s status that may affect his/her mobilization.

I consider the member not mobilization ready. The following action has been taken:

FORWARDED TO ACTIVITY COMMANDING OFFICER FOR FURTHER REVIEW.

DATE:

UNIT COMMANDING OFFICER’S SIGNATURE:

ACTIVITY COMMANDING OFFICER’S SIGNATURE:

DATE:

NAVPERS 1001/3 (Rev. 05-04)

S/N: 0106-LF-130-6300

PAGE 2 OF 2

FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE

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writing ready reserve form part 1

Put down the details in the Do you have a medical problem or, Are you preparing for religious, and Are you a student resident or area.

Entering details in ready reserve form stage 2

Record all information you may need within the section NAVPERS Rev, SN LF, and PAGE OF.

ready reserve form NAVPERS Rev, SN LF, and PAGE OF fields to complete

The field READY RESERVE SCREENING, Position Title, YES NO, b Are you considered a key, Phone, Are you a nonprior service member, and Do you know of any reason why is where to place all sides' rights and responsibilities.

part 4 to entering details in ready reserve form

Fill out the document by analyzing the following sections: Have you been convicted of any, Are you currently involved in any, Have you ever been convicted of a, Is there any other reason why you, CERTIFICATION BY PERSON COMPLETING, DATE, and COMMANDING OFFICERS ENDORSEMENT.

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