PHYSICAL SECURITY AND LAW ENFORCEMENT PLAN--Equivalency Form


APPENDIX G
PHYSICAL SECURITY AND LAW ENFORCEMENT
EQUIVALENCY FORM

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  REQUEST FOR EQUIVALENCY CREDIT FOR MANDATORY FUNCTIONAL TRAINING  
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  Privacy Act Statement: Authority:  EO 9397, November 1943 (SSN)  
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  The principal purpose of this form is to document credit for equivalency  
  training. The purpose of soliciting the Social Security Number is for  
  positive identification and for processing in the Army Civilian Personnel  
  System (ACPERS). Routine use of this form is for verification by the  
  individual's supervisors, Functional Chiefs, Functional Chief Representatives,  
  Personnel Proponents, and the individual's personnel office to ensure  
  that mandatory functional training requirements have been fulfilled.  
  Failure to provide the requested information precludes effective evaluation  
  of equivalency credit for mandatory functional training and update of  
  individual's training record in ACPERS.  
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  SECTION I - EMPLOYEE/COURSE INFORMATION (Type or print in ink)  
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  1. NAME (Last, First, Middle Initial)           2. SOCIAL SECURITY NUMBER  
    
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  3. TITLE                                        4. PAY PLAN/SERIES/GRADE  
    
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  5. CAREER PROGRAM TITLE                         6. CAREER FIELD TITLE  
    
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  5a. Identify Career Program:                    6a. Identify Career Field:  
    
      ----- CAREER PROGRAM #                          ------- CAREER FIELD #  
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  7. IDENTIFICATION OF COURSE FOR WHICH EQUIVALENCY IS REQUESTED:  
    
  7a. ------------ COURSE NUMBER  
    
  7b.  
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  	COURSE LEVEL (Entry, Intermediate, Senior, etc.  
    
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  				COURSE TITLE  
    
  7d. COURSE OFFERED BY ---------------------------------------------------------  
  					NAME  
    
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  		ADDRESS (Include City, State, and Zip Code)  
    
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  WWWW-R (Draft form from DRAFT AR 690-400, Ch 4-10, Sub-Ch 19)  
    
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  8. CURRENT ORGANIZATION/INSTALLATION/MACOM  
     (Include Office Symbol, Location, Address and Zip Code)  
    
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  9. EMPLOYEE's SIGNATURE                         10. DATE SIGNED  
    
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  			SECTION II - TRAINING INFORMATION  
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  11. TRAINING COMPETENCIES ACQUIRED THROUGH (Check applicable one) :  
    
  	----- WORK EXPERIENCE (Attach detailed explanation of work assignments.  
  	      Identify competencies and explain how they were acquired.)  
    
  	----- FORMAL EDUCATION (Attach transcript (s) and description  
  	      of course work, to include course title and course level.  
  	      Identify competencies and explain how they were acquired.)  
    
  	----- CORRESPONDENCE STUDY (Attach certificate (s) and description  
  	      of course work. Identify competencies and explain how  
  	      competencies were acquired.)  
    
  	----- SELF-DEVELOPMENT ACTIVITIES (Attach detailed explanation.  
  	      Identify competencies and explain how they were acquired.)  
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  		SECTION III - SUPERVISOR'S RECOMMENDATION  
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  12. CONCURRENCE/NONCONCURRENCE (Check one)  
    
  ---- Concur - Based on evaluation of individual's documentation, requisite  
       competencies have been attained.  
    
  ---- Non-concur (Return documentation to individual.)  
    
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  13. HOW WERE EQUIVALENCIES DETERMINED? (Check one)  
    
  ---- CASE-BY-CASE BASIS                 ----STANDARD EQUIVALENCY  
    
  (Exceptions: See AR 690-400, Chapter 410, Subchapter 19, Army Civilian  
  Training, Education, and Development System (ACTEDS), paragraph 19-7(4)  
    
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  WWWW-R  
    
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  14. SUPERVISOR'S NAME AND TITLE  
    
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  15. CURRENT ORGANIZATION/INSTALLATION/MACOM  
       (Include Office Symbol, Location, Address and Zip Code)  
    
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  16. SUPERVISOR'S SIGNATURE                      17. DATE SIGNED  
    
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  			SECTION IV - APPROVING AUTHORITY  
    
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  18. APPROVAL/DISAPPROVAL (Check one)  
    
  ---- APPROVED   (Remove attachments and return to individual's supervisor.  
  		Forward DA Form WWWW-R to individual's servicing Civilian  
  		Personnel Office.)  
    
  ---- DISAPPROVE (Return DA Form WWWW-R and attachments to individual's  
  		supervisor.)  
    
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  19. APPROVING OFFICIAL'S NAME AND TITLE  
    
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  20. CURRENT ORGANIZATION/INSTALLATION/MACOM  
      (Include Office Symbol, Location, Address and Zip Code)  
    
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  21. SIGNATURE OF APPROVING OFFICIAL             22. DATE SIGNED  
    
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  		SECTION V - DISPOSITION BY CIVILIAN PERSONNEL OFFICE  
    
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  23. DOCUMENTATION (Check applicable Army Civilian Training Education,  
  and Development System (ACTEDS) Data Identification Number (DIN) Code (s)  
  for use in coding training/equivalency information. Reference Field  
  Army Civilian Personnel System (ACPERS) User's Manual, Chapter 5 (CA),  
  6 (CE) and 8.)  
    
  23a. Date of ACPERS input ----------------  
  			  (year/month/day)  
    
  23b. Was ACPERS DIN FXL used? ------- Yes ------ No  
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  24. FILING INSTRUCTIONS: File DA Form WWWW-R on the right side of the  
  employee's (see item no. 1) Official Personnel Folder.  
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  WWWW-R  


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