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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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