DA Form 1058. Application for Active Duty for Training, Active Duty for Operational Support, and Annual Training for Soldiers of the Army National Guard and U.S. Army Reserve

DA Form 1058 is used by members of the Army National Guard and U.S. Army Reserve to request active duty for training (ADT), active duty for operational support (ADOS), and annual training (AT) for specified periods. It is a voluntary request form that helps determine eligibility and schedules individuals for various types of active duty. Additionally, it establishes the obligation of requested active duty orders.

Key Sections and Fields:

PART I - APPLICANT:

1. TO: The requested destination or location for duty or training.

2. NAME (Last, First, MI): The full name of the applicant.

3a. PERMANENT HOME ADDRESS: The applicant's permanent home address, including ZIP code.

3b. PRIMARY TELEPHONE NUMBER: The primary telephone number of the applicant (including area code).

3c. SECONDARY TELEPHONE NUMBER: The secondary telephone number of the applicant (including area code).

4a. ADDRESS FROM WHICH YOU WILL REPORT FOR DUTY: If different from the permanent home address, this is the address from which the applicant will report for duty (include ZIP code).

4b. PRIMARY TELEPHONE NUMBER: The primary telephone number for the reporting address (including area code).

4c. SECONDARY TELEPHONE NUMBER: The secondary telephone number for the reporting address (including area code).

5. UNIT OF ASSIGNMENT OR ATTACHMENT AND UIC: Indicates the applicant's unit of assignment or attachment and the associated Unit Identification Code (UIC).

6. GRADE: The applicant's military rank or grade.

7. BRANCH: The branch of service in which the applicant serves.

8. GENDER: Specifies the gender of the applicant (Male/Female).

9. DOB: The date of birth of the applicant.

10. MARITAL STATUS: The marital status of the applicant.

11. NO. OF DEPENDENTS: The number of dependents claimed by the applicant.

12. PRIMARY SSI (AOC)/MOS: The primary Skill Qualification Identifier (SQI) or Military Occupational Specialty (MOS) of the applicant.

13. DUTY SSI (AOC)/MOS: The duty-related SQI or MOS of the applicant.

14. ACFT DATE: The date when the Armed Forces Common Test (ACFT) will be administered.

15. HT/WT: Height and weight information of the applicant.

16. REMARKS: Any additional remarks or comments related to the application.

PART II - RECORDS CUSTODIAN:

17. 17. TOTAL YEARS, MONTHS, DAYS OF ACTIVE FEDERAL SERVICE (AFS): Total years, months, and days of active federal service.

18. FOR INDIVIDUAL MOBILIZATION AUGMENTEES ONLY: Specifies the application's purpose (IMA AT, ADT in lieu of IMA AT, etc.).

19. DATES OF ADOS/TTAD/ADT/AT REQUESTED: Indicates the requested dates for ADOS, TTAD, ADT, or AT duty.

20. REMARKS: Any additional remarks or comments related to the application.

PART III - COMMANDER'S SIGNATURE (UNIT COMMANDER):

21. PAY ENTRY BASIC DATE: The date the applicant entered basic pay status.

22. SECURITY CLEARANCE: The security clearance status of the applicant.

23. PROMOTION CONSIDERATION CODE: The code related to promotion consideration.

24. DATE OF RANK: The date of rank of the applicant.

25. RYE DATE: The date the applicant last had a retention/reenlistment interview.

26. ETS (Enlisted)/MANDATORY REMOVAL DATE (Officers): The Estimated Time of Separation (ETS) for enlisted personnel or the Mandatory Removal Date for officers.

27. MANDATORY REMOVAL DATE (Officers): Mandatory Removal Date for officers.

28. PHA DATE: The date of the applicant's Periodic Health Assessment (PHA).

29. HIV TEST DATE: The date of the applicant's HIV test.

30. PANOGRAPHIC DENTAL X-RAY ON FILE: Indicates whether a panoramic dental X-ray is on file for the applicant (Yes/No).

PART IV - CERTIFYING OFFICIAL (COMMANDER):

31. REMARKS: Any additional remarks or comments by the certifying official (commander).

PART V - APPLICANT'S CONSENT:

32. SIGNATURE OF UNIT COMMANDER: The signature of the unit commander.

PART VI - RECORDS CUSTODIAN (continued):

33. NAME, RANK, PHONE, AND EMAIL OF RECORDS CUSTODIAN: Contact information for the records custodian.

Usage Scenario: DA Form 1058 is used when members of the Army National Guard and U.S. Army Reserve wish to apply for various types of active duty, including training, operational support, and annual training. It is a critical document for requesting active duty periods and ensuring that the necessary administrative and logistical arrangements are made. This form helps determine eligibility, record personal information, and gather key details related to the requested duty or training. It is important for soldiers to complete this form accurately and submit it through the proper channels to initiate the request process.