**Report of Career Counseling Session-- Form A - Category-Specific
Counseling**

**Instructions:** This form is to be completed by the CPO or CPO
appointed senior officer counselor upon completion of a career-specific
counseling session and forward to the Office of Commissioned Corps
Operations for inclusion in the officer's personnel file.

**Officer's Rank/Name:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**PHS Service Number:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Date of Counseling: \_\_\_\_/\_\_\_\_/\_\_\_\_\_\_\_ Time:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Officer's Phone Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Officer's
Fax Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Purpose of Counseling**

**\[ \]** CPO Initiated

**\[ \]** Probationary period review

**\[ \]** Promotion non-recommend

**\[ \]** Non-selection for Promotion and placement in the lowest
quartile

**\[ \]** Assimilation non-recommend

**\[ \]** Referred to Chief Professional Officer by a Board for
(specify) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\[ \]** Counselor granted access to electronic Officer Personnel File

**\[ \]** Officer Declines Counseling

**Areas Reviewed**

**\[ \]** Performance **\[ \]** Education/Training/Professional
Development

**\[ \]** Career Progression and Potential **\[ \]** Professional
Contribution and Service to Corps

**\[ \]** Response Readiness **\[ \]** Other (specify below)

**Other Areas Reviewed**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Recommendation(s) by Counselor Included the Following:**

**\[ \]** Create an Individual Development Plan

**\[ \]** Seek Employee Assistance

**\[ \]** Seek a Mentor/

\[ \] Speak with the Agency liaison

**\[ \]** Seek Additional Training (specify)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\[ \]** Other (specify)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Follow-up steps by the officer:**

**\[ \]** Officer agreed to establish a plan to address areas for
development

**\[ \]** Officer indicated he/she will meet with supervisor for
follow-up discussion/planning

\[ \] Officer requested another counselor

\[ \] Officer requested CPO follow-up

\[ \] Other (specify)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Print Counselor's Rank/Name Signature of Counselor Date**

**Note:** This form is to be faxed to eOPF at Fax Numbers:
**301-480-1436** or **301-480-1407**.

**\[ \]** Information shared with officer (send a signed copy of this
report to the officer)