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
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|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 | |8. ORGN, STATION, AND PHONE NO. |
| |ORDINARY |EMERGENCY |––––– |
|––––– | PERMISSIVE TDY | OTHER |––––– |
|––––– |––––– |––––– |
|––––– | |––––– |
|9. |NUMBER DAYS LEAVE |10. |DATES |
|a. ACCRUED |b. REQUESTED |c. ADVANCED |d. EXCESS |a. FROM |b. TO |
|––––– |––––– |––––– |–––––...