From: RANK First MI Last, USNR, XXX-XX-XXXX/XXXX

DD MMM YYY

From: RANK First MI Last, USNR, XXX-XX-XXXX/XXXX To: Commander, Navy Personnel Command (PERS-92) Via: 1) Commanding Officer, [Naval Reserve Unit xxxx]

Subj: APPLICATION FOR VOLUNTARY RECALL TO TEMPORARY ACTIVE DUTY TO (DESIRED POSITION/COMMAND) ICO [RANK/NAME]

Ref: a) MILPERSMAN 1132-010

Encl: 1. Three most recent FITREPS 2. PRIMS report showing PFA history 3. Military/Civilian Resume (optional) 4. Letters of Recommendation (optional) 5. Evidence of relevant education/training/qualifications (optional) 6. Other information the applicant deems relevant to the position (optional)

1. Per reference (a), I hereby apply for recall to subject billet. Enclosures (1) through (x) are provided in support of this application and I make the following statements:

a. I do/do not have 14 or more years of cumulative active duty service (any branch).

b. I have/have not completed one of the following: OCS, DCO school.

c. I am/am not an NROTC/USNA graduate.

d. I will/will not be in zone for promotion on next year’s board.

e. I do/do not desire a household goods (HHG) move in conjunction with this recall.

f. I am/am not a member of the Individual Ready Reserve (IRR).

g. I will reach the age of 60 on: DD MMM YYYY

2. The following information is provided:

a. Desired Billet/Command

b. Date Available

c. Home Address/Phone Number

d. Email Address (official and personal, if desired)

3. [Statements about your qualifications for the position].

4. I certify I have a current Navy Physical Examination in my medical record and that I have no medical condition or legal status that would otherwise preclude my recall to active duty.

2 Subj: APPLICATION FOR VOLUNTARY RECALL TO TEMPORARY ACTIVE DUTY TO (DESIRED POSITION/COMMAND) ICO [RANK/NAME]

5. I understand this is an application for a definite recall. If selected for recall, I agree to initiate my separation physical examination 80 to 90 days prior to my separation date.

6. I certify that I am not identified for mobilization and that I am listed on the current Commander, Navy Reserve Forces Command (CNRFC) Ready Mobilization Pool (RMP). If on the RMP, I understand that I must request permission from CNRFC N35 to be cleared to accept a voluntary recall to active duty.

7. I understand that if selected and offered orders pursuant to this application, my execution of those orders constitute an active duty agreement under Title 10 United States Code Section 12311 and my early release from active duty may be subject to the process and remedies under the same title, Section 12312.

[signature] F. M. LAST