PROTECTED a (When Part 1 Completed)

PROTECTED A (when Part 1 completed) A-PM-245-001/FP-001 Chapter 19, Annex B

NON-EFFECTIVE STRENGTH (NES) STAFFING FORM

Part 1 – Member’s Particulars

SN Rank Surname Initials

MOS ID Unit Name UIC

Part 2 – Unit Clerk Input

Last Attendance. The member’s last attendance day was on: Non-Effective Status Date. Since the member’s last attendance there have been three unit duty periods and at least 30 days elapsed as of: Comments (as applicable): ( ) Date Unit Clerk’s Signature Phone Number

Part 3 – Commanding Officer’s Declaration Declaration. I declare the member to be non-effective and authorize NES status as of the following date: I also direct the contact process to commence immediately Comments (as applicable):

( ) Date Commanding Officer’s Signature Phone Number

Part 4 – Unit Clerk’s Records Action The member’s NES status has been entered into the (check those completed): HRMS RPSR DND 1355 or DND 1356

Part 5 – Unit Representative Contact Process 1. Process to Contact the Member: a. Unit Contact. The unit representative is to contact the member by either: Phone. The member was contacted on: Interview. The member was interviewed on: Letter. The member was advised by letter dated: b. Member’s Response. The member has been contacted, advised of his/her NES status and counselled on the options available. As a result: Active. The member agreed to resume duty on:

PROTECTED A (when Part 1 completed) 19-B1/2 PROTECTED A (when Part 1 completed) Voluntary Release. The member confirmed intent to apply for voluntary release from the CF and will report to the unit to initiate release procedures no later than: Compulsory Release. Attempts have been made to contact the member and the member has not reported to the unit. I recommend that the Commanding Officer complete Part 6 to initiate release proceedings under the Table to QR&O 15.01 Item 5(f) 2. Confirmation of Follow-up Status. The member: resumed attendance on: received approval for ED&T as of: applied for voluntary release on: did not report – complete Part 6. Comments (as applicable):

( ) Date Designated Unit Representative’s Signature Phone Number

Part 6 – Commanding Officer’s Directives Member has Reported: The member has reported to the unit and no further administrative procedures required Compulsory Release. I believe that all reasonable action has been taken to encourage this member to report and resume attendance in accordance with NDHQ Instruction CF Mil Pers) 20/04. Compulsory release procedures shall now be initiated under Item 5(f) of the Table to QR&O 15.01

Comments (as applicable):

( ) Date Commanding Officer’s Signature Phone Number

Part 7 – Unit Clerk’s Record of Action In accordance with Part 6, the member’s NES status has been entered into the (check those completed): HRMS RPSR DND 1355 or DND 1356 Distribution Member Member’s UPF Reproduce this pro forma locally Date of Issue: 28 Feb 09

PROTECTED A (when Part 1 completed) 19-B2/2