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This version of the form is not currently in use and is provided for reference only. Download this version of
DA Form 1058
for the current year.
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
What Is DA Form 1058?
DA Form 1058, Application for Army National Guard and U.S. Army Reserve , is a form issued by the Department of the Army (DA) . An up-to-date DA 1058 fillable form can be downloaded below.
The form is used for determining eligibility for Active Duty and scheduling Army National Guard and U.S. Army Reserve soldiers for Special Work, Temporary Tours, and Annual Training on requested dates. The application - often incorrectly referred to as the "DD Form 1058" or "DA Form 1058-R" - was last revised on September 1, 2017 , with all previous editions obsolete.
DA Form 1058 Instructions
The DA 1058 itself consists of two sections or parts: Part I is for the soldier-applicant. This part of the form must be signed by the soldier themselves: unit representatives are strictly forbidden to sign the form for the soldier. Part II is filed by the records custodian.
- Boxes 1 through 4 identify the soldier, provide their home address, home and business telephone numbers, and the address from which the soldier will report for duty. The last part is filed by soldiers whose Home of Record (HOR) is outside the commuting distance of their duty location.
- The unit of assignments, grade, and branch are provided in Boxes 5, 6, and 7, respectively.
- Boxes 8 to 17 describe the soldier's sex, height, weight, date of birth, marital status, primary SSI, duty SSI and total time spent in active federal service.
- Box 18 is filed by individual mobilization augmentees only.
- Box 19 lists the dates and locations of the Active Duty for Special Work ( ADSW), Temporary Tour of Active Duty (TTAD), Active Duty for Training (ADT), or Annual Training (AT) requested.
- Box 20 assesses medical fitness. The soldier must list the date of their last Periodic Health Assessment (PHA) exam in Box 20a and its location in Box 20b.
- The soldier must sign and date the form in Boxes 21 and 22.
- The soldier then signs Box 23, Remarks, consenting to their release from active duty at the completion of the tour they are applying to.
- Boxes 24 through 33 are filled by the records custodian.
- You are not supposed to fill out Box 34 if it is not showing on your ORDERS QUERY printout. If everything is correct, put SEE ORDERS QUERY in the first line of Box 34a. Not all Title 10 tours show on ORDERS QUERY - must put those down below if you do not have a state order covering that order.
- The custodian then signs the form in Box 35 verifying that the information on DA Form 1058 is accurate and that the soldier meets the medical requirements for tour consideration in NGB PPOM 13-020.
Additional instructions and filing guidelines can be found in the Army Regulation 135-200, Active Duty for Missions, Projects, and Training for Reserve Component Soldiers.
Download 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
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