27. NAME OF SPOUSE: IS SPOUSE MILITARY?

18. U.S. CITIZEN:

4.

DIVISION OFFICER'S PERSONNEL RECORD FORMPrivacy Act

AUTHORITY: Authority to request the information in this form is derived from 5 U.S.C. 301, Department Regulations.PURPOSE: Purpose of this form is to provide the Division Officer with readily accessable data concerning personnel in his/her division.ROUTINE USES: The information is used by the Division Officer to manage and administer his/her personnel; to determine training needed; to recordtraining completed; to maintain readily accessible data concerning performance, work assignment, and other personnel data to enable the DivisionOfficer to guide and counsel those assigned to him/her.DISCLOSURE: Disclosure of the following items of information on this form is manadatory; name, rate, last 4 digits of SSN, local address and phonenumber (if applicable), workcenter/berthing/bunk number (if applicable). Disclosure of the following items of information is voluntary; reenlistmentintentions, rate desired, special qualifications, name of spouse, names and ages of children. Other items of informationmay be obtained from member'sservice record. Failure to provide those required items of information listed above may result in administrative action being taken; no action will betaken if the individual refurses to disclose those voluntary items of information.

1. NAME (LAST, FIRST, MIDDLE): 2. RATE: 3. SSN (LAST 4): USN

USNR

5. NEC/PRI/SEC

6. DEPT/DIV: 7. WORK CENTER: 8. DUTY SECTION: 9. BERTHING: 10. BUNK/LOCKER NUMBER:

11. DATE OF BIRTH: 12. RELIGIOUS PREFERENCE: 13. SECURITY CLEARANCE/ACCESS

14. ADBD: 15. DATE REPORTED: 16. PRD 17. EAOS:

YES NO

19. GENERAL QUARTERS STATION: 20. UNDERWAY WATCH STATION: 21. PHYSICAL READINESS TEST:

22. SPECIAL QUALIFICATIONS OR INTERESTS:

23. PERMANENT HOME ADDRESS AND TELEPHONE NUMBER: 24. LOCAL ADDRESS AND TELEPHONE NUMBER:

25. MARITAL STATUS: 26. NUMBER OF DEPENDENS: YES

NO

28. NAMES AND AGES OF CHILDREN:

29. PRIMARY NEXT OF KIN: 30. RELATIONSHIP: 31. PRIMARY NEXT OF KIN'S ADDRESS AND TELEPHONE NUMBER:

32. PREVIOUS DUTY

DATE REPORTED UNIT DIVISION DESCRIPTION OF DUTY:

FOR OFFICIAL USE ONLYPRIVACY SENSITIVE

PAGE 1 OF 3NAVPERS 1070/6 (REV. 06-07)

SUPPORTING DIRECTIVE OPNAVINST 3120.32C

S/N: 0107-LF-127-5400

ELIGIBLE FOR NEXT RATE:

HIGH SCHOOL COLLEGE

DIVISION OFFICER'S PERSONNEL RECORD FORM (CONTINUED)

36. PERFORMANCE TRAITS

EVALUATIONDATE

PROFESSIONALKNOWLEDGE

QUALITYOF WORK

EQUALOPPORTUNITY

MILITARYBEARING/

CHARACTER

PERSONAL JOBACCOMPLISHMENT/

INITIATIVETEAMWORK

LEADERSHIP(OPTIONAL FOR

E1-E3)

37. NAVY-WIDE EXAMINATION ELIGIBILITY (ENTER DATE COMPLETED OR OTHER REQUIRED DATA THAT SHOWS COMPLETION)

PERFORMANCETEST

ENLISTEDWARFARE NLTCEVALUATION

RECOMMENDATION PFA CITIZENSHIPCLEARANCEPROPERPATH OF

ADV

"A" or "C"SCHOOL REGA

34. ASVAB SCORES

FORM 5/6/7GI NO AD WK AR SP MK EI MC GS SI AI

FORM 8/9/10GS AR WK PC NO CS AS MK MC EI VE

FORM 11/12/13GS AR WK PC MK EI AS MC AO VE CD

33. FORMAL EDUCATION

9 10 11 12

HIGH SCHOOL GEDCOLLEGE CLEP

1 2 3 4

MAJOR

PART I PART II PART III PART IV PART V

35. SHIPBOARD QUALIFICATIONS (DATES QUALIFIED)

GENERAL PQS DAMAGE CONTROL 3-M FIRE FIGHTING SHIP CLASS REQUAL DC SHIP CLASS

DATE OF PRESENT RATE:

YES NO

PAGE 2 OF 3FOR OFFICIAL USE ONLYPRIVACY SENSITIVE

NAVPERS 1070/6 (REV. 06-07)

DATE ELIGIBLE FOR NEXT RATE:

S/N: 0107-LF-127-5400

DIVISION OFFICER'S PERSONNEL RECORD FORM (CONTINUED)

38. NAVAL EDUCATION RECORD

SERVICE SCHOOLS

TITLE DATECOMPLETED GRADE GRADEDATE

COMPLETEDTITLE

MILITARY CORRESPONDENCE COURSES

TITLE DATECOMPLETED GRADE GRADEDATE

COMPLETEDTITLE

COLLEGE/OTHER SCHOOLS

TITLE DATECOMPLETED GRADE GRADEDATE

COMPLETEDTITLE

39. AWARDS AND COMMENDATIONS:

40. COMMENTS (GOALS, EXPECTATIONS, OBJECTIVES AND OTHER COMMENTS):

PAGE 3 OF 3FOR OFFICIAL USE ONLYPRIVACY SENSITIVE

NAVPERS 1070/6 (REV. 06-07) S/N: 0107-LF-127-5400