REASSIGNMENT WORKSHEET

							                REASSIGNMENT WORKSHEET

                PLEASE PRINT ALL RESPONSES CLEARLY

NAME: _________________________________

SSN: ___________________________________

RANK: _________________________________

CURRENT UNIT: _______________________________________________________

DUTY PHONE: _________________________________________________________

HOME/CELL PHONE: __________________________________________________

REASSIGNED TO: ______________________________________________________

REPORT DATE: ________________________________________________________

NUMBER OF PCS LEAVE DAYS YOU PLAN TO TAKE: ____________________

AVAILABILITY DATE (OVERSEAS ONLY): ______________________________

LEAVE ADDRESS AND PHONE NUMBER:
_______________________________________
_______________________________________
_______________________________________

CURRENT ADDRESS:
_______________________________________
_______________________________________
_______________________________________

FAMILY MEMBERS (CIRCLE ONE): YES OR NO

IF APPLICABLE

TDY OPTION (CIRCLE ONE): ENROUTE OR RETURN

MODE OF TRANSPORTATION (CIRCLE ONE): POV OR COMMERCIAL

______________________________________________________
SERVICE MEMBER’S SIGNATURE/ DATE