Transcription of LEAVE REQUEST/AUTHORIZATION REVERSE OF …
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LEAVE REQUEST/AUTHORIZATION REVERSE OF …
SEE REVERSE FOR. LEAVE REQUEST/AUTHORIZATION INSTRUCTIONS FOR COMPLETING THIS FORM ARE PRIVACY ACT. STATEMENT. NAVCOMPT FORM 3065 (3PT) (REV. 2-83) ON THE REVERSE OF PART 3. 1. DATE OF request 2. FOR ADMIN. USE ONLY. APPROVAL OF THIS LEAVE IS. NOT VALID WITHOUT CONTROL NO. LEAVE CONTROL NO. 3. SSN 4. NAME (Last, First, MI) 5. PAYGRADE. 6. SHIP/STATION 7. DEPT/DIV 8. DUTY SECTION 9. DUTY PHONE. 10. TYPE LEAVE FOR USE OUTUS ONLY 12. MODE OF TRAVEL. 11a. Leaving Area of PERMDUTYSTA. REGULAR SICK EMERGENCY AIR BUS. YES NO. 11b. Taking LEAVE INCONUS CAR TRAIN. SEPARATION RETIREMENT OTHER. YES NO. 13. DAYS REQUESTED 14. FROM (Hour, Date) (YYMMDD) 15.
29b. date (yymmdd) 10. type leave see reverse for privacy act statement 21. ration status (enlisted) 20. leave address
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