Fillable Printable Reassignment Status And Election Statement
Fillable Printable Reassignment Status And Election Statement
Reassignment Status And Election Statement
1. NAME
7. CURRENT UNIT
2. SSN 3. GRADE 4. PMOS 5. ASI
8. CURRENT UPC
9. GAINING UNIT
12. ARRIVAL DATE (YYYYMMDD)
11. TODAY'S DATE (YYYYMMDD)
15. AI LANGUAGE
10. EDAS CYCLE NO.
14. AI ASI 13. AI MOS
YES NO N/A
16. Is the Soldier being assigned to a special management command (table 2-5)?
Section B - General Eligibility Status
Section A - Special Management Command Status
PRIVACY ACT STATEMENT
The "Blanket Routine uses" set forth at the beginning of the Army's Compilation of Systems of Records Notices also
applies to this system.
(1) To conduct initial screening of reassignment cycle to determine Soldier's eligibility to comply; and (2) basis for
initiating specific assignment processing (deletion/deferments; additional service; or any other special processing required).
REASSIGNMENT STATUS AND ELECTION STATEMENT
PREVIOUS EDITIONS ARE OBSOLETE.
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For use of this form, see AR 600-8-11; the proponent agency is DCS, G-1.
PART I - MILITARY PERSONNEL DIVISION/PERSONNEL SERVICE COMPANY
INSTRUCTIONS: The Military Personnel Division/Personnel Service Company will answer all the questions in Part I (Sections A, B, and C) after
comparing the EDAS Cycle with the Personnel Qualification Record (DA Form 2-1) of the Soldier. A checkmark in any of the "Yes" blocks will require a
comment in the "Remarks" block indicating the reason for further action, review, or possible removal from this assignment. If a question does not apply,
check the "N/A" block. This form pertains to enlisted Soldiers only.
Title 10, USC, Sections 3010, 8012 and 5031, and Title 5, USC, Section 301 and E.O. 9397 (SSN).
Authority:
Principal
Purpose:
Routine Uses:
Disclosure:
Section C - Time in Service Requirements Status
17. Is the Soldier currently assigned to another installation?
18. Has the Soldier already received assignment instructions from which he/she has not been officially deleted?
19. Does the Soldier have less than 120 days notice to prepare for this assignment?
20. Will the Soldier be reassigned during the same fiscal year of his/her last "cost" PCS?
21. Will the Soldier be reassigned before completing at least 12 months at his/her current duty station?
22. Will the Soldier's stabilization period terminate after the assignment arrival date?
23. Does the Soldier's PULHES contain a "3" or "4"?
24. Does the Soldier's PMOS differ from the assignment MOS?
25. Are the special qualifications required for this assignment different from those currently possessed by the Soldier?
Are the PRP requirements for this assignment different from those currently possessed by the Soldier?
Will the Soldier who is being reassigned from CONUS to CONUS have less than 24 months service remaining (as of
the last day of the arrival month) until his/her ETS?
Will the initial term Soldier have insufficient service remaining (as of the last day of the arrival month) to complete
at least the "all others" tour prior to ETS upon arrival in the gaining overseas area?
Will the career Soldier have sufficient service remaining (as of the last day of the arrival month) until his/her ETS to
serve the "all others tour" for the overseas area?
Will the Soldier who is being reassigned from OCONUS (long tour area) to CONUS have less than 13 months
service remaining from his/her DEROS until his/her ETS?
Will the Soldier who is being reassigned from OCONUS (short tour area) to CONUS have less than 7 months service
remaining from his/her DEROS until his/her ETS (less Johnston Island and Enewetak.)?
Will the Soldier be reassigned prior to the completion of his/her Foreign Service Tour Extension (FSTE)?
Is the Soldier's DEROS after the assignment arrival date?
26.
27.
28.
29.
30.
31.
32.
33.
34.
DA FORM 5118, OCT 2012
Disclosure of information is voluntary. However, failure to disclose this data may result in unnecessary hardship on the
Soldier and/or Family members. Failure to disclose data will not automatically exempt Soldier from selected reassignment.
Are the prerequisites for TDY schooling or training required for this assignment different from those currently
possessed by the Soldier?
6. CONTROL LANGUAGE
36a. REASSIGNMENT CLERK'S SIGNATURE
36b. DATE (YYYYMMDD)
35. REMARKS (Annotate any additional information or discrepancies)
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I am not
aware of any medical conditions that would prevent me from worldwide deployability.
I am
55a.
1. NAME
6. CONTROL LANGUAGE
9. GAINING UNIT
12. ARRIVAL DATE (YYYYMMDD)
2. SSN
13. AI MOS
3. GRADE 4. PMOS
14. AI ASI
10. EDAS CYCLE NO.
5. ASI
8. CURRENT UPC
11. TODAY'S DATE (YYYYMMDD)
15. AI LANGUAGE
58a. BATTALION COMMANDER'S SIGNATURE
58b. DATE (YYYYMMDD)
Section D - Duty Status
Is the Soldier currently assigned to a unit scheduled for permanent overseas deployment (other than unit TDY
movement such as a REFORGER)?
Is the Soldier currently attached to another installation for the purpose of processing a personnel action?
Is the Soldier currently assigned to another unit?
Is the Soldier in an AWOL status?
Is the Soldier presently confined?
Is the Soldier presently undergoing any medical or dental treatment that would prevent this reassignment?
Is the Soldier awaiting court or trial appearance as a defendant?
37.
38.
39.
40.
41.
42.
43.
44.
Is the Soldier pending an early release from active duty?
Is the Soldier pending a Medical Evaluation Board (MMRB/PEB)?
Is the Soldier pending a PMOS reclassification?
Is the Soldier under suspension of favorable personnel actions (FLAGGED)?
Is the Soldier enrolled in phase III of the Alcohol and Drug Abuse Prevention and Control Program (ADAPCP)?
Is the Soldier scheduled for any schooling not in conjunction with this assignment?
Has the Soldier applied for specialized training?
45.
46.
47.
48.
49.
50.
51.
52.
53.
INSTRUCTIONS: The Battalion S1 will answer all the questions in Part II (Sections D and E). A checkmark in any of the "Yes" blocks will require a
comment in the "Remarks" block indicating the reason for further action, review, or possible removal from this assignment. If a question does not
apply, check the "N/A" block. The Battalion S1 must sign the completed statement and return it to the MPD/Personnel Service Company with the
completed Soldier Status and Election Statement attached.
PART II - BATTALION STATUS
Section E - Pending Action Status
YES NO N/A
Is the Soldier currently TDY from his/her home station and not scheduled to return at least 60 days prior to the first day
of the arrival month?
54.
DEPLOYABILITY CERTIFICATION: I certify that this Soldier's deployable status is: 56a.
Ready Not Ready
Physician's Name and title or position:
Physician's Signature:
56b.
56c.
REMARKS (Annotate any additional information or discrepancies):57.
56d. DATE (YYYYMMDD)
Is the Soldier being delayed from complying with these assignment instructions due to administrative processing
errors?
Are there any circumstances not listed above that would preclude the Soldier from complying with these assignment
instructions?
Medical Readiness Code (MRC):
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7. CURRENT UNIT
Initials:
55b. Date (YYYYMMDD):
7. CURRENT UNIT
1. NAME
6. CONTROL LANGUAGE
9. GAINING UNIT
12. ARRIVAL DATE (YYYYMMDD)
2. SSN
13. AI MOS
3. GRADE 4. PMOS
14. AI ASI
10. EDAS CYCLE NO.
5. ASI
8. CURRENT UPC
11. TODAY'S DATE (YYYYMMDD)
15. AI LANGUAGE
75. REMARKS (Annotate any additional information or discrepancies.)
76a. SOLDIER'S SIGNATURE
76b. DATE (YYYYMMDD)
INSTRUCTIONS: You will answer all the questions in Part III (Sections F and G). A checkmark in any of the "Yes" blocks will require a comment in the
"Remarks" block indicating the reason for further action, review, or possible removal from this assignment. If a question does not apply, check the "N/A"
block. You must sign the completed statement and return it to the Battalion S1.
PART III - SOLDIER STATUS AND ELECTION STATEMENT
Section F - Personal Status
YES NO N/A
Do you have an approved retirement date?
If you are being assigned to an airborne position, do you wish to terminate your airborne status?
59.
60.
61.
Do you have an enlistment or reenlistment commitment for other than the areas of this assignment?
Are you a pregnant Soldier?
Are you a sole parent or married to an Army Soldier?
Is your spouse pregnant?
Do you have an extreme Family situation that meets the requirements outlined in table 2-1, AR 600-8-11?
62.
63.
64.
65.
66.
Section G - To and From OCONUS Status
67.
Have you failed to complete initial entry training (12 weeks military training or its equivalent) required before your
overseas movement?
68.
69.
70.
71.
Do you desire to report in early to the gaining oversea command? 72.
If you have received assignment instructions to a dependent restricted area (short tour area), do you want to
participate in the Homebase Assignment Program?
If you have received assignment instructions to a dependent restricted area (short tour area), do you want to
participate in the Advanced Assignment Program?
73.
74.
Are you being assigned to a duty or an area for which you have a reassignment restriction for the reason of prior
sensitive duty assignment?
Do you have any Family members with a physical, emotional, developmental or intellectual disorder who are not
enrolled in the Exceptional Family Member Program?
If you have received assignment instructions to Turkey, are you or your spouse a Turkish or dual U.S.-Turkish
national?
Are you being assigned overseas to a country where you committed a crime that resulted in civil or military
imprisonment or conviction by a foreign tribunal?
Are you being involuntarily reassigned to an unaccompanied short tour area following 12 cumulative months TDY
during a 24-month period?
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DA FORM 5118, OCT 2012
DA FORM 5118, OCT 2012
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7. CURRENT UNIT
1. NAME 2. SSN 3. GRADE 4. PMOS 5. ASI
6. CONTROL LANGUAGE
9. GAINING UNIT
13. AI MOS 14. AI ASI
10. EDAS CYCLE NO.
8. CURRENT UPC
11. TODAY'S DATE (YYYYMMDD)
15. AI LANGUAGE
83. REMARKS (Annotate any additional information or discrepancies.)
84a. SOLDIER'S SIGNATURE
84b. DATE (YYYYMMDD)
INSTRUCTIONS: You will answer all the questions in Part IV (Section H). A checkmark in any of the "Yes" blocks will require a comment in the
"Remarks" block indicating the reason for further action, review, or possible removal from this assignment. If a question does not apply, check the "N/
A" block. You must sign the completed statement and return it to the Battalion S1.
PART IV - WARTIME STATUS
Section H - Personal Status
YES NO N/A
Have you applied for Conscientious Objector status?
Are you a sole surviving son or daughter?
77.
78.
79.
Are you a former Peace Corps member being reassigned to the country in which you have served?
Are you a former Prisoner of War or Hostage being reassigned to the country where you were held captive?
Have you been hospitalized at least 30 days outside a hostile fire area due to a wound received in that area?
80.
81.
82.
Are you being reassigned to a hostile fire area and have immediate Family members whose service in that area
resulted in death, disability, missing in action, or prisoner of war status?
12. ARRIVAL DATE (YYYYMMDD)
