
NCO$EVALUATION$REPORT$(SGT)!
For$use$of$this$form,$see$AR#623!3"and$DA#PAM#623!3!"the"proponent"agency "is"DCS,"G!1.!
SEE#PRIVACY#ACT#STATEMENT#
IN#AR#623!3!
PART%I%!!ADMINISTRATIVE+DATA!
a.! NAME%(Last,'First,'Middle'Initial)! b.#SSN#(or#DOD#ID#No.)!
c.#RANK!
d.#DATE#OF#RANK! e.##PMOSC!
f.#! UNIT,&ORG,&STATION,&ZIP&CODE&OR&APO,&MAJOR&COMMAND! g.###STATUS#CODE! h.! UIC! i.#REASON#FOR#SUBMISS IO N!
j.! PERIOD'COVERED!
k.##RATED#
MONTHS!
l.##NONRATED#
CODES!
m.#NO#OF#
ENCLOSURES!
n.#RATED#NCO'S#EMAIL#ADDRESS#(.gov&or&.mil)!
FROM! THRU!
YEAR! MONTH&DAY! YEAR! MONTH&DAY!
PART%II%!!AUTHENTICATION!
a1.$$$NAME$OF$RATER!(Last,'First,'Middle'Initial)!
a2.$SSN$(or$DOD$ID$No.)!
a3.! !"#$!%&'&()*"#+!$!
a4.! DATE%(YYYYMMDD)!
a5.! RANK! PMOSC/BRANCH!
ORGANIZATION! DUTY%ASSIGNMENT!
a6.$$RATER'S$EMAIL$ADDRESS$(.gov$or$.mil)!
b1.$$$NAME$OF$SENIOR$RATER!(Last,'First,'Middle'Initial)!
b2.$SSN$(or$DOD$ID$No.)!
b3.! !"#$%&'&()"&*!'!$+#(),&"! b4.! DATE%(YYYYMMDD)!
b5.! RANK! PMOSC/BRANCH!
ORGANIZATION! DUTY%ASSIGNMENT!
b6.$$SENIOR$RATER'S$EMAIL$ADDRESS$(.gov!
or#.mil)!
c1.$$SUPPLEMENTARY$
REVIEW&REQUIRED?!
YES!
NO!
c2.$NAME$OF$SUPPLEMENTARY$REVIEWER!
(Last,'First,'Middle'Initial)!
c3.$RANK! !PMOSC/! ORGANIZATION! DUTY%ASSIGNMENT%
BRANCH!
c4.$COMMENTS$
ENCLOSED?!
YES! NO!
c5.$SUPPLEMENTARY$REVIEWER'S$SIGNATURE! c6.$DATE(YYYYMMDD)!
c7.$SUPPLEMENTARY$REVIEWER'S$EMAIL$ADDRESS!
(.gov&or&.mil)!
RATED&NCO:&I&understand&my&signature&does& not&constitute&agreement&or&disagreement&with&the&assessments&of&the&rater&and&senior#rater.#I#further#understand#my#signature#verifies#that#the#administrative#data#
in#Part#I,#the#rating#officials#and#counseling#dates$ in$Part$II,$the$duty$description$in$Part$III,$and$the$APFT$and$height/weight$entries$in$Part$IVa$and$IVb$are$correct.$I$have$seen$the$completed$report.$ I$am$aware$of$
the$appeals$process$of$AR$623!3.!
d1.! COUNSELING*DATES!
INITIAL! LATER! LATER! LATER!
d2.! RATED&NCO'S&SIGNATURE!
d3.! DATE%(YYYYMMDD)!
PART%III%!!DUTY%DESCRIPTION! (Rater)!
a.###PRINCIPAL#DUTY#TITLE! b.#! DUTY%MOSC!
c.! DAILY&DUTIES&AND&SCOPE!(To$include,$as$appropriate,$people,$equipment,$facilities,$and$dollars)!
d.! AREAS%OF%SPECIAL%EMPHASIS!
e.! APPOINTED)DUTIES!
PART! IV! !!! PERFORMANCE! EVALUATION,! PROFESSIONALISM,! ATTRIBUTES,! AND! COMPETENCIES!(Rater)!
a.! APFT%Pass/Fail/Profile:! Date:! b.##Height:!
Weight:!
Within&Standard?!
(Comments)required)for)"Failed")APFT,)"No")APFT,)or)"Profile"!when%it%precludes%performance%of%duty,%and%"No"%for%Army%Weight%Standards.)%!
Reset%Item%a.%APFT/Pass/Fail/Profile!
c.! CHARACTER:""(Include"bullet"comments"address in g "
Rated&NCO's&performance&as&it&relates&to&adherence&to&
Army%Values,%Empathy,%Warrior%Ethos/Service(Ethos,(and(
Discipline.*Fully*supports*SHARP,*EO,*and*EEO.)!
MET! DID#NOT#MEET#
STANDARD! STANDARD!
COMMENTS:!
DA#FORM#2166!9!1,#NOV#2015!
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