Appendix CSMR PROMOTION PACKET CHECKLIST. Name Unit Rank Print Clearly Unit Commander G-1. A. Signed Checklist (this document)

Transcription

1 Appendix CSMR PROMOTION PACKET CHECKLIST Name Unit Rank Print Clearly Unit Commander G-1 A. Signed Checklist (this document) B. Biographical Summary (Use example in Appendix 2) Include copies of Course completions for all military education (To include, but not limited to: BOC certificate, NCO/SNCO course diplomas, Officers professional development course diplomas (i.e. SOS, CSC, SSS).You need not include routine or ancillary training. If certificates are unavailable, provide a report from a military information system listing the completion of the military courses required for promotion and highlight those mandated courses on the form. C. 3 Most Recent and Consecutive Years NCOERs/OERs or one Special NCOER/OER with explanation why 3 are not available D. Completed CA SMR Form 13A (Appendix 3) E. Signed Medical Release dated no earlier than 1 September 2013 (Appendix 4) F. Signed Acceptance of Conditions for Provisional Promotion (if applicable) (Appendix 5) G. Highest Civilian (High School or College) Education Diplomas or Transcripts H. One photo as described in LOI I. Appendix 6, if applicable (Specialty Officers Only) 1-Page Numbers

2 Appendix 2 SAMPLE BIOGRAPHICAL SUMMARY SMITH, John A. XXX-XX-6789 Captain, CSMR Date and place of Birth: 1 August 1975, Midlothian, VA Present Assignment: Enlisted Service: Battery Commander, E Battery, 111 th Field Artillery, 29th Infantry Division (L) Army National Guard, Sandston, VA Simultaneous Membership Program (Cadet E-5), C Company, 276th Engineer Battalion, West Point, VA Commission: Army ROTC at Virginia Commonwealth University, Richmond, VA. 15 May 1999 Years of Commissioned Service: 12 years, 9 months Total Years of Service: 14 years, 4 months Military Schools Attended: Year Completed US Army Airborne School, Basic Parachutist Course 1998 US ROTC Leadership Development Assessment Course 1999 USAFAS, Field Artillery Officer Basic Course (FAOBC) 1999 USAFAS, Field Artillery Officer Advanced Course (FAOAC) 2004 CSMR Basic Orientation Course (BOC) 2006 FEMA Courses Completed Year Completed IS-100.b (ICS 100) Introduction to Incident Command System 2006 IS-200.b (ICS 200) ICS for Single Resources and Initial 2006 Action Incidents IS-700.a National Incident Management System (NIMS), 2007 An Introduction Emergency Qualification Courses Date Completed ARC Standard First Aid Course 16 September 2012 ARC CPR Course 22 September 2012 Civilian Education: Local High School VCU, Richmond, VA Duke University, Durham, NC 2-Page Numbers

3 US Decorations/Badges: Army Commendation Medal (ARCOM) Army Achievement Medal (AAM), 3 awd Armed Forces Expeditionary Medal (AFEM) Armed Forces Service Medal (AFSM) Army Reserve Component Achievement Medal, with 1 Bronze Oak Leaf Cluster (ARCAM) National Defense Service Medal, with Bronze Service Star Device (NDSM) Armed Forces Reserve Medal, with Bronze Hourglass, M Device, and 2 Device (AFRAM) Army Service Ribbon NATO Medal Basic Parachutist Badge Army Superior Unit Award State Decorations/Badges: California Medal of Merit, with 1 Bronze Oak Leaf Cluster (CAMM) Virginia Commendation Medal Virginia Service Ribbon with Two Dogwood Blossoms (12 years) Chronological list of Appointments: SMP Cadet E-5 ARNG 30 October 1997 Second Lieutenant ARNG 15 May 1999 First Lieutenant ARNG 30 May 2002 Captain ARNG 26 May 2005 Captain CSMR 1 January 2006 Chronological Record of Duty Assignments: From: To: ARNG - Not on Active Duty SMP Cadet E-5 Oct 97 Sep 98 USAR - Not on Active Duty USAR Control Group William & Mary ROTC Sep 98 May 99 USAR Control Group (delayed) May 99 Jul 99 ACTIVE DUTY Student Officer, USAFAS Jul 99 Jan 01 ARNG - Not on Active Duty Recon/Survey Officer, HHSB/1-246 FA, 29 ID (L) Jan 01 Apr 03 Fire Direction Officer, A/1-246th FA, 29 ID (L) Apr 03 May 05 ARNG Active Guard and Reserve (AGR), Title 32 Officer Strength Manager, Det 4 (R&R), STARC Oct 03 Oct 05 CSMR S-3, Troop Command Jan 06 Present 2-2 Page Numbers

4 Appendix 3 CSMR Form 13A 2014 CSMR PROMOTION RECOMMENDATION Under the provisions of CSMR Regulations, the following individual is recommended for promotion consideration by the CSMR NCO, Warrant Officer or Officer Promotion Selection Board. 1. IDENTIFICATION DATA a. NAME (Last, First, Middle Initial) b. CURRENT GRADE: GRADE NOMINATED FOR: ` c. DOR: SSN: (last 4 digits) DOB: d. CURRENT TDA ASSIGNMENT: (para, line) e. DUTY TITLE: AUTH GRADE: NOTE: In general, if recommended for promotion, the authorized grade of the Duty Assignment at the time that promotion is requested must be at least the grade of promotion. g. CURRENT MAILING ADDRESS/TELEPHONE Street or P.O. Box City ZIP Home Phone Business Phone 2. HEIGHT AND WEIGHT CERTIFICATION a. By signing this CSMR Form 13A at paragraph 7, the Unit Commander/CSMR Chief of Staff/ CSMR General Staff Director certifies that this officer/warrant officer/enlisted person meets the height and weight standards of CSMR REG CSMR PARTICIPATION RECORD Total hours of CSMR Volunteer Service: Hours Summary of Participation as of: (1) Current Calendar Year 2013 (2) Previous Calendar Year 2012 (3) Previous Calendar Year 2011 Volunteer Hours 3-Page Numbers

5 Note: Total CSMR volunteer service hours while a member of the CSMR must be provided and then provide a summary of only the previous three calendar years of Volunteer Activity documented by certified CSMR Form 20s. Do not attach the Form 20s, only refer to them when reporting the hours on this form. 4. OTHER EVENTS Participation in significant projects, missions, and/or events reflecting on you qualification for promotion. This provides the Promotion Board with additional information that has the potential to favorably reflect on the promotion candidate as to whether or not the candidate is qualified for promotion. 5. PROMOTION CANDIDATE SIGNATURE For applicable enlisted personnel (E8), indicate interest in RPL consideration for future consideration for a CSM/CCM position: Yes, interested in CSMR CSM/CCM RPL Listing No, not interested in CSMR CSM/CCM RPL Listing By signing this CSMR Form 13A this officer/warrant officer/enlisted person seeking promotion certifies that all the information contained in this form and the attached Military Biography is true and correct and is a true and correct representation of the officer s/warrant officer s/enlisted person s civilian education, awards, decorations, and achievements and completion of Military Education Courses, Branch Qualification Courses, FEMA Courses, Emergency Qualification Courses, and other military training courses. Candidate: Printed Name Signature/Date 6. COMMANDER S RECOMMENDATION FOR AND JUSTIFICATION FOR PROMOTION ACTION Show summary of applicant s prior performance of duty and reasons for recommending promotion at this time. The commander s recommendation and justification is significant to the Promotion Board s assessment of whether or not the promotion candidate is qualified for promotion. 3-2 Page Numbers

6 7. RECOMMENDED BY: By signing below, I recommend the promotion candidate for promotion for the reasons stated in Paragraph 6 above and certify that I have reviewed this packet and find that this packet is complete and adheres to the 2014 Promotion Boards Letter of Instruction. For Unit-Level Applicants Only: Unit Commander Printed Name Signature/Date Unit CSM/CCMS or Unit Senior NCO Signature/Date Printed Name (For Enlisted Promotion Packets) Senior/Major Command (i.e. RSC) Signature/Date Commander Printed Name ************************* For HQ CSMR Applicants Only: Directorate or Senior Officer Printed Name Signature/Date CSMR CCMS Printed Name (For Enlisted Promotion Packets) Signature/Date CSMR COS Printed Name Signature/Date 8. ENDORSEMENTS: 3-3 Page Numbers

7 Appendix 4 MEDICAL RELEASE 2014 CSMR PROMOTION PACKET CHECKLIST CSMR Member Name: Social Security (Last Four Digits): Rank: Unit: Assignment: Description of Duties: I have completed a medical assessment for the individual named above and attest that he/she can safely participate in his/her normal activities as described. Signature Date: Name and Organization Stamp Here: NOTE: The Medical Release may be signed by a duly licensed MD, DO, Physician s Assistant (PA), or Nurse Practitioner. 1-Page Numbers

8 Appendix 5 ACCEPTANCE OF CONDITIONS FOR PROVISIONAL PROMOTION 2014 CSMR PROMOTION PACKET CHECKLIST I, Alexander, Ronald C., understand that if the 2014 CSMR Promotion Board selects me for promotion to the next higher rank that it will be on a provisional basis pending completion of the next available qualifying course(s) for the new grade. Course(s) required but unavailable since last promotion Board: I further understand that if I fail to complete the next qualifying course(s) when made available to CSMR members that my provisional promotion will be revoked and I will immediately revert back to my previous grade. Signature Date Unit Commander s Signature Date 1-Page Numbers

9 Appendix 6 OFFICER SPECIALTY DIRECTORATE RECOMMENDATION FOR PROMOTION 2014 CSMR PROMOTION PACKET CHECKLIST CSMR Member Name: Social Security (Last Four Digits): Rank: Specialty (Circle One): Medical JAG Chaplain Unit: Assignment: Description of Duties: I have reviewed the promotion application for the individual named above and support his/her promotion to the next rank. Printed Name Signature Date 1-Page Numbers