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Click ‘Get Form’ to open DA Form 4991 R in the editor.
Begin by filling in your personal information in the designated fields, including your name, rank, DODI, unit/organization, and ETS date.
In Section A, initial next to each statement to confirm your understanding of the consequences of declining additional service. Ensure you complete all required initials.
Provide the name, rank, and unit of your career counselor along with their signature and the date when counseling occurred.
In Section B, acknowledge counseling by signing and dating where indicated. If you refuse to sign, have a witness complete the necessary fields.
Finally, in Section C, ensure that your immediate commander or first sergeant reviews and signs off on the form with their details.
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by A Regulation 2014 Cited by 1 A DA Form 4991R (Declination of Continued Service Statement) is required for Soldiers serving on their second or subsequent enlistmentRead more
This document does not necessarily address all applicable heath and safety risks and precautions with respect to particular materials, conditions, or proceduresRead more
Nov 1, 2004 Continued Service Statement (DA Form 4991 or NGB Form 4991). F. Has been involuntarily removed from a unit (Selected Reserve) assignment. 1.Read more
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