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PERSONNEL QUALIFICATION RECORD (Cont.)                                                               NAME:
             SECTION II - CLASSIFICATION AND ASSIGNMENT DATA (Cont.)                                    SECTION III - SERVICE, TRAINING AND OTHER DATES
13.                                  PILOT RATINGS                                     18.     APPOINTMENTS AND REDUCTIONS                     CONT 19. SPECIALIZED TRAINING              CONT
             ORIGINAL              DATE               CURRENT                 DATE                                   EFFECTIVE          DATE OF                  SUBJECT              DATE
                                                                                       GRADE          COMP
                                                                                                                       DATE            ELIG./RANK           ATP 21-114 (BCT)
14.                             FLYING STATUS                                  CONT                                                                       Geneva-Hague
                                                                                                                                                          Conventions

                                                                                                                                                          Military Justice
INSTRUMENT CERTIFICATION                                                                                                                                  Benefits of
                                                                                                                                                          Honorable
15.                INTERNSHIPS, RESIDENCIES AND FELLOWSHIPS                    CONT                                                                       Discharge
             HOSPITAL                      TYPE OF SERVICE           MONTHS     YEAR




16.          HOSPITAL/TEACHING APPOINTMENTS AND PRIVATE PRACTICE               CONT    20. BASIC ENLISTED SERVICE DATE (BESD)
      FROM         THRU            INSTITUTION/LOCATION              TYPE      DURAT   21.                          TIME LOST (Sec. 972, Title 10, USC)                                   CONT
                                                                                             FROM            THRU          DAYS                                REASON




                                                                                                             SECTION IV - PERSONAL AND FAMILY DATA
17.                CIVILIAN EDUCATION AND MILITARY SCHOOLS                     CONT    22.            PHYSICAL STATUS               23.           PLACE OF BIRTH AND CITIZENSHIP
              SCHOOL               MAJOR/COURSE/MOSC         DURAT    COMP      YEAR     HEIGHT         WEIGHT         GLASSES      SELF
                                                                                                                        YES    NO SPOUSE
                                                                                       DATE OF EXAM                                 CITIZENSHIP OF SPOUSE
                                                                                       24.        NUMBER OF DEPENDENTS              25.              HOME OF RECORD/ADDRESS
                                                                                              ADULT              CHILDREN




                                                                                       26.                                        CIVILIAN OCCUPATION
                                                                                       JOB TITLE:
                                                                                       DOT CODE                          CRITICAL OCCUPATION          NO. MONTHS               MOSC
                                                                                                                                                      EMPLOYED
                                                                                                                                 YES           NO
                                                                                       DUTIES PERFORMED




                                                                                       EMPLOYER


DA FORM 2-1, MAR 2008                                                                                                                                                                 APD PE v2.00
                                                                                                                                                                                      PAGE 2 OF 4
PERSONNEL QUALIFICATION RECORD (Cont.)                                              NAME:
                                                            SECTION V - MISCELLANEOUS
27. REMARKS                                                         28.                                        ITEM CONTINUATION
                                                                      ITEM
                                                                                                                        DATA
                                                                       NO.




                                                                                              SECTION VI - RESERVE COMPONENT DATA   (YYYYMMDD)

                                                                    31a. READY RESERVE OBLIGATION EXPIRATION DATE:
                                                                      b. READY RESERVE START DATE:
                                                                      c. SERVICE OBLIGATION EXPIRATION DATE:
                                                                      d. MANDATORY REMOVAL FROM ACTIVE STATUS:
                                                                      e. RETIREMENT YEAR ENDING DATE:
                                                                    32.              DATE               33. SIGNATURE
29. DATE DA FORM 20B OR DA FORM 2-2 PREPARED: (YYYYMMDD)                  PREPARED          REVIEWED
30. DATE DUPLICATE DA FORM 2-1 SUBMITTED: (YYYYMMDD)
                                                                                                                                                 APD PE v2.00
DA FORM 2-1, MAR 2008
                                                                                                                                                 PAGE 3 OF 4
PERSONNEL QUALIFICATION RECORD (Cont.)                                                NAME:
                                                   SECTION VII - CURRENT AND PREVIOUS ASSIGNMENTS
34.                                                               RECORD OF ASSIGNMENTS                                                       CONT
                                                                                                                        NON-       NON-
  EFFECTIVE                                                                                                             DUTY      RATED
                                                                                            ORGANIZATION AND STATION    DAYS      DAYS      TYPE
    DATE         DUTY MOSC                       PRINCIPAL DUTY
                                                                                              OR OVERSEA COUNTRY          BP        EP     REPORT
  (YYYYMMDD)
                                                                                                                       YYYY/MM   YYYY/MM




DA FORM 2-1, MAR 2008                                                                                                                      APD PE v2.00
                                                                                                                                           PAGE 4 OF 4

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A2 1

  • 1.
  • 2. PERSONNEL QUALIFICATION RECORD (Cont.) NAME: SECTION II - CLASSIFICATION AND ASSIGNMENT DATA (Cont.) SECTION III - SERVICE, TRAINING AND OTHER DATES 13. PILOT RATINGS 18. APPOINTMENTS AND REDUCTIONS CONT 19. SPECIALIZED TRAINING CONT ORIGINAL DATE CURRENT DATE EFFECTIVE DATE OF SUBJECT DATE GRADE COMP DATE ELIG./RANK ATP 21-114 (BCT) 14. FLYING STATUS CONT Geneva-Hague Conventions Military Justice INSTRUMENT CERTIFICATION Benefits of Honorable 15. INTERNSHIPS, RESIDENCIES AND FELLOWSHIPS CONT Discharge HOSPITAL TYPE OF SERVICE MONTHS YEAR 16. HOSPITAL/TEACHING APPOINTMENTS AND PRIVATE PRACTICE CONT 20. BASIC ENLISTED SERVICE DATE (BESD) FROM THRU INSTITUTION/LOCATION TYPE DURAT 21. TIME LOST (Sec. 972, Title 10, USC) CONT FROM THRU DAYS REASON SECTION IV - PERSONAL AND FAMILY DATA 17. CIVILIAN EDUCATION AND MILITARY SCHOOLS CONT 22. PHYSICAL STATUS 23. PLACE OF BIRTH AND CITIZENSHIP SCHOOL MAJOR/COURSE/MOSC DURAT COMP YEAR HEIGHT WEIGHT GLASSES SELF YES NO SPOUSE DATE OF EXAM CITIZENSHIP OF SPOUSE 24. NUMBER OF DEPENDENTS 25. HOME OF RECORD/ADDRESS ADULT CHILDREN 26. CIVILIAN OCCUPATION JOB TITLE: DOT CODE CRITICAL OCCUPATION NO. MONTHS MOSC EMPLOYED YES NO DUTIES PERFORMED EMPLOYER DA FORM 2-1, MAR 2008 APD PE v2.00 PAGE 2 OF 4
  • 3. PERSONNEL QUALIFICATION RECORD (Cont.) NAME: SECTION V - MISCELLANEOUS 27. REMARKS 28. ITEM CONTINUATION ITEM DATA NO. SECTION VI - RESERVE COMPONENT DATA (YYYYMMDD) 31a. READY RESERVE OBLIGATION EXPIRATION DATE: b. READY RESERVE START DATE: c. SERVICE OBLIGATION EXPIRATION DATE: d. MANDATORY REMOVAL FROM ACTIVE STATUS: e. RETIREMENT YEAR ENDING DATE: 32. DATE 33. SIGNATURE 29. DATE DA FORM 20B OR DA FORM 2-2 PREPARED: (YYYYMMDD) PREPARED REVIEWED 30. DATE DUPLICATE DA FORM 2-1 SUBMITTED: (YYYYMMDD) APD PE v2.00 DA FORM 2-1, MAR 2008 PAGE 3 OF 4
  • 4. PERSONNEL QUALIFICATION RECORD (Cont.) NAME: SECTION VII - CURRENT AND PREVIOUS ASSIGNMENTS 34. RECORD OF ASSIGNMENTS CONT NON- NON- EFFECTIVE DUTY RATED ORGANIZATION AND STATION DAYS DAYS TYPE DATE DUTY MOSC PRINCIPAL DUTY OR OVERSEA COUNTRY BP EP REPORT (YYYYMMDD) YYYY/MM YYYY/MM DA FORM 2-1, MAR 2008 APD PE v2.00 PAGE 4 OF 4