Da Form 1058 R

A fillable DA Form 1058 R is used by the US Army. It is also known as an Application for Active Duty. Members of the US Army Reserve or the Army National Guard use it to request that they be moved to active duty. In addition to completing this form, it may also be necessary to include documentation related to medical fitness.

What is a Da form 1058 R?

This form will be used by the Department of the Army. A DA Form 1058-R is also known an Application for Active Duty. This could be active duty for training or special work. This form will serve as an official request for active duty by someone who is a member of the U.S. Army Reserve or the Army National Guard.
This form must be filled out completely for someone to be considered for an active duty tour. It will require a lot of personal information like full name, identification number, information specific to the individual’s Army rank, and contact information. To see if someone is fit enough for active duty, the last time the person was examined by a medical professional will need to be listed, and documentation may be requested.

How to complete a Da form 1058 R  (Step by Step)

To complete a DA Form 1058R, you will need to provide the following information:

Part I - Application

  • To
  • Name (last, first, middle initial)
  • Permanent home address
  • Address from which you will report for duty
  • Home telephone number
  • Business telephone number
  • Unit of assignment or attachment
  • Grade
  • Branch
  • Sex (male or female)
  • Date of birth
  • Marital status
  • Number of dependents
  • Primary SSI (AOC)/MOS
  • Duty SSI (AOC)/MOS
  • Height
  • Weight
  • Indication whether you are drawing a pension, disability compensation, or retired pay from the U.S. Government
  • Total years, months, days of active federal service (AFS)
  • For individual mobilization augmentees, indication that application is for: IMA AT, ADT in lieu of IMA AT or Additional ADT
  • Dates of ADSW/TTAD/ADT/AT requested: first choice and second choice number of days, beginning date/time, location, duty/training agency
  • Indication that “To the best of my knowledge and belief, I am physically qualified for active military duty.
  • Last examination date and location
  • Signature 
  • Date
  • Signature of applicant

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Sample Da Form 1058 R


Sample Da Form 1058 R

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