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From: RANK First M. Last, USNR, 123-45-6789/xxx5
To: Commander, Navy Personnel Command (PERS-921A)
Via: 1) Commanding Officer, [Naval Reserve Unit xxxx]
2) Commanding Officer, [Naval Reserve Activity]
Subj: APPLICATION FOR RECALL
Ref: a) MILPERSMAN 1132-010
Encl: 1) Military/Civilian Resume' [1-3 pages max]
2) Last Two FITREPS,
3) Pertinent Quals/Training
4) Last PRT Results (PRIMS Print Out)
1. Per reference (a), I hereby apply for a three year recall to active duty into a Reserve Program billet. Enclosures (1) through (4) are provided in support of this application and the following notes apply:
a. Desired Billet: [per the advertisement message/webpage]
b. No Earlier Than Start Date:
c. Desired Start Date:
d. Home Address:
e. Phone:
f. E-mail:
g. Other:
1) Have you been on a recall within the last six years? If so, please list dates? ___________________________________
2) Have you executed any ADSW orders within the last six years? If so, please list dates? ____________________________
3) Are you currently executing a set of recall orders? If so, please clarify. ______________________________________________
4) Would you have to be released from a set of orders (ADT, ADSW, Recall) prior to the desired start date? If so, please clarify. __________________________________________________________________
5) Will you exceed 17 years of Active Service (not commissioned service) at the end of these orders? Yes / No
6) At the completion of these orders will you have five years of continuous active service? Yes / No
7) Have you had any back to back orders within the last five years that have less than a thirty one day break between them? If so, please clarify. __________________________________________________
8) Are you up for promotion on next year’s board? Yes / No
9) Have you failed of selection (FOS) for the next higher pay grade? Yes / No
10) Is a household goods (HHG) move desired? Yes / No
11) If a HHG is not desired / required, please list the location (name and address) were you will have your orders endorsed prior to the actual start date; for example, the local NOSC or PSD.
12) Are you a member of the Individual Ready Reserve(IRR)?
Yes / No
13) Are you currently in an active drilling status and have less than 4 Unexcused Absences (UA) in the last 12 months? Yes / No
14) Will you reach the age of 62 before completion of the orders?
2. [Statements about your qualifications for the position].
3. [Additional statements, if needed].
4. I certify I have a current Navy Physical Examination in my medical record and that I have no medical condition or legal status that would otherwise preclude my recall to active duty.
5. I understand this is an application for a 12 - 36 month recall that will not normally be extended. If selected for recall, I agree to initiate my separation physical examination 80 to 90 days prior to my separation date.
[signature]
F. M. LAST
................
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