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Accurate completion of the Navy Reserve Qualification Questionnaire by each Selected reserve officer is important both to the individual and to the Navy. This questionnaire serves several purposes:
It provides current information on your experience, education and skills for use in determining mobilization assignments. It provides information on your foreign language proficiency, civilian education and professional achievements to boards considering you for selection to the next higher grade, or to disposition boards considering you for retention in, or release from, the Navy Reserve.
It provides information required by the Armed Forces Reserve Act of 1952, as revised, codified and enacted in Title 10, United States Code, affecting your priority of recall or mobilization and your present status in the Navy Reserve.
Privacy Act Statement Education/ Civilian Experience Reserve Service Information Foreign Language Proficiency Signature / Date / Personal Information
Authority: Authority for requesting this information is contained in 10 United States Code, Chapter 11
Purpose: To provide current information concerning your skills, education and civilian experience for use in determining appropriate mobilization assignments, promotion opportunity, and status in the Navy Reserve. Completion and return of this form is mandatory; failure to complete this form may affect priority on mobilization assignment and status in the Navy Reserve.
High School, College or Professional (Name and Location) Attended (From / To) Semester Hours (Credits) Degree (Title/Date) Major Field of Study Specialization within major
NAVY PERSONNEL COMMAND (PERS-45E) 5720 INTEGRITY DRIVE MILLINGTON, TN 38055
Name and Address of Employer (if Federal Government, include title of agency, grade and series) Kind of Business Exact Title of Your Position (give present and former position if change occurred during the past year) Present Position (Years and Months) Number of Employees Supervised (Present Position) Former Position (Years and Months) Brief Description of Duties and Responsibilities. Indicate special skills or licenses in effect. (Bar membership, CPA, Denomination of member of the Chaplain Corps, Medical or Dental Certification, Merchant Marine, Professional Engineer or Engineer-in-Training, Registered Architect or Architect-in-Training, etc.)
DOD requires each service to capture and maintain current and accurate civilian employment-related information on each Reserve member. The purpose for collecting this information is to achieve fair treatment between members in the Ready Reserve who are being considered for recall to active duty without their consent, ensure that there will be no significant attrition of Ready Reserve members or units during a mobilization and to inform Reserve Component members and their employers of their rights, benefits, and obligations under the Uniformed Services Employment and Reemployment Rights Act (USERRA). Please go to the following web address and provide the requested data:
Reserve Unit Title (Address not required) Billet Title and Months in this Billet Command Holding Your Service Record (Address not required) Annual Training During the Past Fiscal Year Duties Dates
Language Proficiency Source Code and Description:
Proficiency Rating (Digit Code):
Rate for Speak / Write / Read / Listen
Signature Date Social Security Number Designator Fiscal Year of Report
Commander Navy Personnel Command (PERS-911) 5720 Integrity Drive Millington, TN 38055