AIRBORNE CHECKLIST - Bravo Bombers

AIRBORNE CHECKLIST

LAST NAME: _______________________________________________ FIRST NAME: ______________________________________________ MIDDLE: __________________________________________________ SSN: _______________________________________________________ MOS: ______________________________________________________ SERIES AND LINE NUMBER: ________________________________ TRAINING UNIT: ___________________________________________

REQUIRED FORMS

DA FORM 4187: ______________ SIGNED BY SOLDIER: YES / NO SIGNED BY COMMANDER: YES / NO COMMANDER NOTES: ______________________________________ ____________________________________________________________ VOLUNTEER STATEMENT IAW AR 614-2OO: _________________ AIRBORNE PHYSICAL: _______________ DATED: ______________ DA FORM 7O5: _____________ DATE OF PT TEST: ______________

AIRBORNE VOLUNTEER STATEMENT

1. I hereby volunteer for Airborne training and/or assignment under the provisions of chapter 6, AR 614-200. The following information is submitted:

a. PMOS

.

b. Service Component

.

2. I volunteer to perform frequent aircraft flights, parachute jumps, and to participate in the realistic training while undergoing Airborne training and/or performing Airborne duty. I also understand that I may be assigned to an Airborne unit for a period of not less than 12 months upon satisfactory completion of the prescribed course.

3. My current period of service expires on

. Upon

approval of this application, I understand that I will be required to extend my enlistment

or reenlist in accordance with AR 601-280 before departure, if necessary to meet the

length of service requirement (12 months after completion of training).

4. There has been no significant change in my physical condition since the time of the physical examination. I consider myself qualified for Airborne training and/or Airborne assignment.

5. Upon successful completion of Airborne training, I agree to complete a minimum of 12 months on Airborne status. I may not voluntarily terminate my Airborne status unless Physically disqualified.

__________________________ Signature/Date

__________________________ Printed Name

__________________________ SSN

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