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Download DA Form 1058-r, also known as Application For Active Duty For Training, Active Duty For Special Work, Temporary Tour Of Active Duty And Annual Training For Soldiers Of The Army National Guard And The U.S. Army Reserve. This form is designed to decide eligibility. It’s also designed for scheduling, for active duty, special work or active duty for training on specific dates.

How To Fill-In

Step 1 – Part 1 – Applicant (Read instructions in AR 135-200 before completing this form) as follows:

  • 1. To (include zip code)
  • 2. Name (Last, First, MI format)
  • 3. a. Permanent Home Address (include zip code)
  • b. Home Telephone Number (include area code)
  • c. Business Telephone Number (include area code)
  • 4.a. Address From Which You Will Report For Duty (if different from home address – include zip code)
  • b. Home Telephone Number (include area code)
  • c. Business Telephone Number (include area code)
  • 5. Unit Of Assignment Or Attachment
  • 6. Grade
  • 7. Branch
  • 8. Sex (M/F )
  • 9. Date Of Birth
  • 10. Marital Status
  • 11. Number Of Dependents
  • 12. Primary SSI (AOC)/MOS
  • 13. Duty SSI (AOC)/MOS
  • 14. Height
  • 15. Weight
  • 16.  Read and answer question in block 16.
  • 17. Total Years, Months, Days Of Active Federal Service

Step 2 – For Individual Mobilization Augmentees Only – This Application is for (check the appropriate respsonse):

  • IMA AT
  • ADT in lieu of IMA AT
  • Additional ADT

Step 3 – Dates of ADSW/TTAD/ADT/At Request

  • 19.a. First Choice
  • Number Of Days
  • Beginning Date/Time
  • Location
  • Duty/Training Agency
  • 19.b. Second Choice
  • Number Of Days
  • Beginning Date/Time
  • Location
  • Duty/Training Agency

Step 4 – Section 20. – Read the acknowledgement- if agreed provide the following information:

  • 20.a. Last Examined On
  • b. At
  • 21. Signature
  • 22. Date (yyyy/mm/dd format)

Page 2 – 23. Read the acknowledgement. If agreed:

  • Place signature on “Signature of Applicant” line

Step 5 – Part ll – Records Custodian – This area is designated for filling in by the Records Custodian Only:

  • 24. Pay Entry Basic Date
  • 25. Security Clearance
  • 26. Promotion Consideration Code
  • 27. Date Of Rank
  • 28. Rye Date
  • 29. EST (enlisted)
  • 30. Mandatory Removal
  • 31. UIC
  • 32. HIV Test Date
  • 33. Panographic Dental X-Ray On File (yes or no)

Step 6 – List all previous AD, TTAD, AT, ADT, IADT and ADSW in the previous and current fiscal year showing inclusive dates, purpose of tours and HQ or agency to which attached – complete as follows:

  • a. Period of Training/Duty
  • From
  • To
  • Number Of Days
  • b. Type Training/Duty (AD, TTAD etc.)
  • c. Location/Installation
  • d. Duty Peformed
  • e. Signature Of Unit Commander
  • f. Date

Step 7 – Record Custodian Information:

  • 35.a. Name Of Records Custodian (Last, First, MI format)
  • b. Grade
  • c. Signature
  • d. Date

These forms are fillable online and/or printable for manual use and sending.

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