Authentication and Emergency Leave Transportation
REQUEST AND AUTHORITY FOR LEAVE
This form is subject to the Privacy Act of 1974. For use of this form, see AR 600-8-10.
The proponent agency is ODCSPER. (See Instructions on Reverse) 1. CONTROL NUMBER
PART I
2. NAME (Last, First, Middle Initial) 3. SSN 4. RANK 5. DATE
6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) 7. TYPE OF LEAVE
1ordinary
0 EMERGENCY
8. ORGN, STATION, AND PHONE NO.
0 PERMISSIVE TDY
0other
_____________________________
9. NUMBER DAYS LEAVE 10. DATES
a. ACCRUED b. REQUESTED c. ADVANCED d. EXCESS a. FROM b. TO
11. SIGNATURE OF REQUESTOR
12. SUPERVISOR RECOMMENDATION/SIGNATURE
1 APPROVAL 0 DISAPPROVAL
13. SIGNATURE AND TITLE OF APPROVING AUTHORITY
14. DEPARTURE
a. DATE b. TIME c. NAME/TITLE/SIGNATURE OF DEPARTURE AUTHORITY
15. EXTENSION
a. NUMBER DAYS b. DATE APPROVED c. NAME/TITLE/SIGNATURE OF APPROVAL AUTHORITY
16. RETURN
a. DATE b. TIME c. NAME/TITLE/SIGNATURE OF RETURN AUTHORITY
17. REMARKS I understand that this absence is not directed by any official of the U.S. Government. I further understand that I cannot conduct public business under this authorization. Accordingly, I will not be entitled to reimbursement for travel, per diem, or any other expenses. I understand that I have the right to cancel it at any time and return to my regular place of duty.
Chargeable Leave is from to
Chargeable leave is from to
PART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL
18. You are authorized to proceed on official travel in connection with emergency leave and upon completion of your leave and travel will return
This form is subject to the Privacy Act of 1974. For use of this form, see AR 600-8-10.
The proponent agency is ODCSPER. (See Instructions on Reverse) 1. CONTROL NUMBER
PART I
2. NAME (Last, First, Middle Initial) 3. SSN 4. RANK 5. DATE
6. LEAVE ADDRESS (Street, City, State, ZIP Code and Phone No.) 7. TYPE OF LEAVE
1ordinary
0 EMERGENCY
8. ORGN, STATION, AND PHONE NO.
0 PERMISSIVE TDY
0other
_____________________________
9. NUMBER DAYS LEAVE 10. DATES
a. ACCRUED b. REQUESTED c. ADVANCED d. EXCESS a. FROM b. TO
11. SIGNATURE OF REQUESTOR
12. SUPERVISOR RECOMMENDATION/SIGNATURE
1 APPROVAL 0 DISAPPROVAL
13. SIGNATURE AND TITLE OF APPROVING AUTHORITY
14. DEPARTURE
a. DATE b. TIME c. NAME/TITLE/SIGNATURE OF DEPARTURE AUTHORITY
15. EXTENSION
a. NUMBER DAYS b. DATE APPROVED c. NAME/TITLE/SIGNATURE OF APPROVAL AUTHORITY
16. RETURN
a. DATE b. TIME c. NAME/TITLE/SIGNATURE OF RETURN AUTHORITY
17. REMARKS I understand that this absence is not directed by any official of the U.S. Government. I further understand that I cannot conduct public business under this authorization. Accordingly, I will not be entitled to reimbursement for travel, per diem, or any other expenses. I understand that I have the right to cancel it at any time and return to my regular place of duty.
Chargeable Leave is from to
Chargeable leave is from to
PART II - EMERGENCY LEAVE TRANSPORTATION AND TRAVEL
18. You are authorized to proceed on official travel in connection with emergency leave and upon completion of your leave and travel will return