Fill Out a Valid Da 2166 9 1 Form Fill Out Your Document

Fill Out a Valid Da 2166 9 1 Form

The DA Form 2166-9-1 is an official document used to evaluate the performance of Non-Commissioned Officers (NCOs) in the U.S. Army, specifically for the rank of Sergeant. This form captures essential administrative data, performance evaluations, and overall potential assessments. Accurate completion of the DA Form 2166-9-1 is critical for maintaining effective personnel records and ensuring proper evaluation of service members.

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Table of Contents

Form Overview

Fact Name Description
Form Purpose The DA 2166-9-1 form is used to evaluate the performance of Non-Commissioned Officers (NCOs) in the U.S. Army.
Governing Regulations This form is governed by Army Regulation (AR) 623-3 and DA Pamphlet (PAM) 623-3.
Privacy Act Compliance The form includes a Privacy Act Statement, ensuring that personal information is protected in accordance with AR 623-3.
Submission Details It requires detailed administrative data, including the rated NCO's name, Social Security Number, and performance period.
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Documents used along the form

The DA Form 2166-9-1 is an essential document for evaluating non-commissioned officers (NCOs) in the U.S. Army. Alongside this form, several other documents are commonly used to ensure a comprehensive evaluation process. Below is a list of these documents, along with a brief description of each.

  • DA Form 2166-9-2: This form is used for evaluating NCOs at the rank of staff sergeant and above. It provides a structured format for rater and senior rater assessments, focusing on leadership and performance.
  • DA Form 4856: The Developmental Counseling Form is utilized to document counseling sessions between leaders and soldiers. It addresses performance issues, goals, and professional development, contributing to the overall evaluation process.
  • DA Form 705: This form records the results of the Army Physical Fitness Test (APFT). It is important for assessing a soldier's physical readiness and overall fitness, which are crucial components of performance evaluations.
  • DA Form 5500/5501: These forms are used to assess body composition. They help determine if soldiers meet Army weight standards, which is a factor in overall evaluations and readiness.

Each of these documents plays a vital role in the evaluation process, helping to ensure that NCOs receive fair and accurate assessments of their performance and potential. Together, they contribute to the professional development and readiness of soldiers in the Army.

Document Sample

HQDA#:

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NCO EVALUATION REPORT (SGT)

For use of this form, see AR 623-­3 and DA PAM 623-­3;; the proponent agency is DCS, G-­1.

SEE PRIVACY ACT STATEMENT

IN AR 623-­3

PART I -­ ADMINISTRATIVE DATA

a.NAME (Last, First, Middle Initial)

b. SSN (or DOD ID No.)

c. RANK

d. DATE OF RANK

e. PMOSC

f. UNIT, ORG, STATION, ZIP CODE OR APO, MAJOR COMMAND

g. STATUS CODE

h. UIC

i. REASON FOR SUBMISSION

j. PERIOD COVERED

FROMTHRU

YEAR MONTH DAY

YEAR MONTH DAY

k.RATED MONTHS

l.NONRATED CODES

m. NO OF ENCLOSURES

n. RATED NCO'S EMAIL ADDRESS (.gov or .mil)

PART II -­ AUTHENTICATION

a1. NAME OF RATER (Last, First, Middle Initial)

a2. SSN (or DOD ID No.)

a3. RATER'S SIGNATURE

a4. DATE (YYYYMMDD)

a5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

a6. RATER'S EMAIL ADDRESS (.gov or .mil)

b1. NAME OF SENIOR RATER (Last, First, Middle Initial)

b2. SSN (or DOD ID No.)

b3. SENIOR RATER'S SIGNATURE

b4. DATE (YYYYMMDD)

b5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

b6. SENIOR RATER'S EMAIL ADDRESS (.gov or .mil)

c1. SUPPLEMENTARY

c2. NAME OF SUPPLEMENTARY REVIEWER

c3. RANK

PMOSC/

ORGANIZATION

DUTY ASSIGNMENT

REVIEW REQUIRED?

(Last, First, Middle Initial)

 

 

BRANCH

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c4. COMMENTS

 

c5. SUPPLEMENTARY REVIEWER'S SIGNATURE

c6. DATE(YYYYMMDD)

 

c7. SUPPLEMENTARY REVIEWER'S EMAIL ADDRESS

ENCLOSED?

 

 

 

 

 

 

(.gov or .mil)

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RATED NCO: I understand my signature does not constitute agreement or disagreement with the assessments of the rater and senior rater. I further understand my signature verifies that the administrative data in Part I, the rating officials and counseling dates in Part II, the duty description in Part III, and the APFT and height/weight entries in Part IVa and IVb are correct. I have seen the completed report. I am aware of the appeals process of AR 623-­3.

d1. COUNSELING DATES INITIAL

LATER

LATER

LATER

d2. RATED NCO'S SIGNATURE

d3. DATE (YYYYMMDD)

PART III -­ DUTY DESCRIPTION (Rater)

a. PRINCIPAL DUTY TITLE

b. DUTY MOSC

c.DAILY DUTIES AND SCOPE (To include, as appropriate, people, equipment, facilities, and dollars)

d.AREAS OF SPECIAL EMPHASIS

e.APPOINTED DUTIES

PART IV -­ PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)

a. APFT Pass/Fail/Profile:

Date:

b. Height:

Weight:

Within Standard?

(Comments required for "Failed" APFT, "No" APFT, or "Profile" when it precludes performance of duty, and "No" for Army Weight Standards.) Reset Item a. APFT/Pass/Fail/Profile

c.CHARACTER: (Include bullet comments addressing Rated NCO's performance as it relates to adherence to Army Values, Empathy, Warrior Ethos/Service Ethos, and Discipline. Fully supports SHARP, EO, and EEO.)

MET

DID NOT MEET

STANDARD

STANDARD

COMMENTS:

DA FORM 2166-­9-­1, NOV 2015

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RATED NCO'S NAME (Last, First, Middle Initial)

SSN (or DOD ID No.)

THRU DATE

 

 

 

PART IV -­ PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)

d. PRESENCE: (Military and professional

COMMENTS:

bearing, Fitness, Confidence, Resilience.)

 

MET

DID NOT MEET

 

STANDARD

STANDARD

 

e. INTELLECT: (Mental agility, Sound judgment, COMMENTS:

Innovation, Interpersonal tact, Expertise.)

MET

DID NOT MEET

STANDARD

STANDARD

f. LEADS: (Leads others, Builds trust, Extends COMMENTS:

influence beyond the chain of command, Leads by

example Communicates.)

 

MET

DID NOT MEET

STANDARD

STANDARD

g. DEVELOPS: (Creates a positive command/ COMMENTS:

workplace environment, Fosters esprit de corps,

Prepares self, Develops others, Stewards the

profession.)

 

MET

DID NOT MEET

STANDARD

STANDARD

 

 

h. ACHIEVES: (Gets results.)

COMMENTS:

MET

DID NOT MEET

STANDARD

STANDARD

 

 

 

 

 

 

RATER OVERALL PERFORMANCE

 

i. I currently rate

NCOs in this grade.

 

COMMENTS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART V -­ SENIOR RATER OVERALL POTENTIAL

a. Select one box representing Rated

b. COMMENTS:

 

NCO’s potential compared to others in the

 

 

same grade whom you have rated in your

 

 

career. I currently senior rate

 

 

NCOs in this grade.

 

 

 

 

 

 

 

 

 

 

 

 

MOST QUALIFIED

 

 

 

 

 

 

HIGHLY QUALIFIED

 

 

QUALIFIED

 

 

 

 

 

 

NOT QUALIFIED

 

 

 

 

 

 

 

 

 

c. List two successive assignments and one broadening assignment (3-­5 years).

 

Successive Assignment:

1)

 

 

2)

Broadening Assignment:

 

 

 

DA FORM 2166-­9-­1, NOV 2015

 

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