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D11N Assignment to Duty Request Form
Phase 1 of the D11 AUX Reconstitution plan limits the activities approved at this time. Only the activities listed below are approved by the appropriate order issuing authority (OIA).
In order to be assigned to duty for these activities you must follow all personal protective equipment and social distancing requirements.
Every Auxiliarist participating in one of the approved activities must complete and submit the AUX COVID-19 High Risk Certification Form to the DIRAUX office and appropriate OIA in order to be considered for assignment to duty.
Due to current District Eleven policy prohibiting active duty members from commuting in uniform, Auxiliary members will only be authorized to wear and AUX polo shirt and khakis or clean pants/short for all approved activities.
The Assignment to Duty Request form and AUX-COVID-19 High Risk Certification form must be submitted to the DIRAUX shared email inbox (D11AUXNorthern@uscg.mil) at least one week prior to the requested assignment to duty date.
All other non-virtual Auxiliary activities at the request of an active duty unit may only be approved by the D11 Commander via the waiver process.
Use a separate form for each type of activity.
Member Name
*
First
Last
Member ID#
*
Email
*
Division and Flotilla
*
Example 06-05
Date Submitted: (at least 7 days prior to requested activity date :
*
MM
/
DD
/
YYYY
Event Date
*
MM
/
DD
/
YYYY
Days of event
*
Please select
1
2
3
4
5
6
Nature of request: Only one per form
*
Please select
Land Based PATON Verification
No Contact Marine Dealer Visitation
Telecommunications site visits
Vessel Safety Checks
Test Proctoring
Citizenship Verification
Are you currently certified in Core Training and any competency required for requested mission?
*
Please select
Yes
No
Do you have a COVID 19 High Risk Assessment form on file (submitted to D11AUXNorthern@uscg.mil)
*
Please select
Yes
No
Any changes to report since filing?
*
Please select
Yes
No
Where will you be performing activity
*
Details of requested event, including expected duration, number of VSCs or PVs to be performed, and any other amplifying information to explain activity
*
By submitting this form you agree that you have reviewed the pertinent documents and certify that you understand the guidelines set forth for required PPE and will provide same at your expense.
*
Please select
Yes
No
