Form Navpers 1001 3 PDF Details

Form Navpers 1001 3, also known as the Reserve Enlisted Record and Report of Separation (ERR&S), is a document that is used to report any separations that occur while in the reserves. This document is important because it provides information on the person's military record, including all awards and decorations they have earned. The ERR&S must be completed within 48 hours of the separation and turned into unit personnel or the servicing Personnel Service Center.

The following are some details about form navpers 1001 3. It's really worth making the effort to study this before you start filling out your form.

QuestionAnswer
Form NameForm Navpers 1001 3
Form Length2 pages
Fillable?Yes
Fillable fields65
Avg. time to fill out13 min 34 sec
Other namesnavpers 1080 3 pdf, navpers 3 form, navpers 3 form fillable, 1001 questionnaire

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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