DA Form 67-9-1 Fillable Template

INDICATE YOUR MAJOR PERFORMANCE OBJECTIVES DA FORM 67-9-1 OCT 2011 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2 APD PE v1.00ES NAME a. APFT DATE HEIGHT b. FOR OFFICIAL USE ONLY FOUO SEE PRIVACY ACT STATEMENT IN AR 623-3. OFFICER EVALUATION REPORT SUPPORT FORM For use of this form see AR 623-3 the proponent agency is DCS G-1. PART I - RATED OFFICER IDENTIFICATION RANK SSN DATE OF RANK YYYYMMDD NAME OF RATED OFFICER Last First MI UNIT ORG* STATION ZIP CODE OR APO MAJOR COMMAND STATUS CODE FROM DATE UIC BRANCH DESIGNATED/PMOS WO SPECIALITIES CMD CODE PSB CODE PART II - AUTHENTICATION NAME OF RATER Last First MI POSITION NAME OF INTER* RATER Last First MI NAME OF SENIOR RATER Last First MI PART III - VERIFICATION OF FACE-TO-FACE DISCUSSION MANDATORY RATER / RATED OFFICER INITIAL FACE-TO-FACE COUNSELING ON DUTIES RESPONSIBILITIES AND PERFORMANCE OBJECTIVES FOR THE Date Rated Soldier Initials Rater Initials Senior Rater Initials CURRENT RATING PERIOD TOOK PLACE ON Review PERIODIC RATER / RATED OFFICER FOLLOW-UP FACE-TO-FACE COUNSELINGS Dates Rated Soldier Initials PRINCIPAL DUTY TITLE POSITION AOC / BR a* STATE YOUR SIGNIFICANT DUTIES AND RESPONSIBILITIES b. LIST YOUR SIGNIFICANT CONTRIBUTIONS c* LIST ANY UNIQUE PROFESSIONAL SKILLS OR AREAS OF EXPERTISE OF VALUE TO THE ARMY d. IF UNABLE TO SERVE IN THE CURRENT BRANCH/CAREER FIELD IN WHICH BRANCH/CAREER FIELD WOULD YOU PREFER TO SERVE e. LIST YOUR SIGNIFICANT CONTRIBUTIONS c* LIST ANY UNIQUE PROFESSIONAL SKILLS OR AREAS OF EXPERTISE OF VALUE TO THE ARMY d. IF UNABLE TO SERVE IN THE CURRENT BRANCH/CAREER FIELD IN WHICH BRANCH/CAREER FIELD WOULD YOU PREFER TO SERVE e.