Access Data Sheet

VFA-81 ACCESS DATA SHEET

Name (Last, First, Middle: / SSN:
RANK/RATE / WARFARE QUAL: / DATE ON BOARD: / PNEC: / DNEC
RACE: / DOB: / DESIG AND BSC (OFFICERS ONLY)
WORKCENTER: / SHIFT: / DUTY SECTION:
RECALL
HOME ADDRESS: / HOME PHONE: / OTHER PHONE:
SPOUSE/NOK
SPOUSES NAME:
______/ SPOUSES ADDRESS, PHONE NUMBER AND EMAIL ADDRESS: ______
______
______
Hurricane Evac Info/NEXT OF KIN (Primary if Single, Secondary if married)
NAME: ______
RELATIONSHIP: ______
ADDRESS: ______
______
PHONE NUMBER:

DEPENDANTS:

NAME

______
______
______/

DOB

______
______
______/

RELATIONSHIP

______
______
______
TRANSFER AND CAREER DATA
ADSD: / EAOS: / TIME IN RATE: / DATE OF RANK: / NEXT RANK:
REPORT DATE: / PREVIOUS COMMAND: / PREVIOUS DUTY STATION:
AWARDS
NAME OF AWARD
______
______
______
______
______
______/ DATE RECEIVED:
______
______
______
______
______
______/ PRESENTED BY:
______
______
______
______
______
______
DATE ELIGIBLE FOR GOOD CONDUCT AWARD:
PRIVACY ACT STATEMENT
All information will be safeguarded IAW the Privacy Act Statement. Requested information is for the Command Personnel Module which will be used for recall bills, performance evaluations, training records, pay matters and security clearance data.

Entered by Admin/Pers Clerk: ______Date: ______