Transcription of Request for or Notification of Absence
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Example: bankruptcy
Request for or Notification of Absence
Request for or Notification of AbsenceNo. of Hours RequestedFrom DateThru DateHourHourRevised Schedule for (Date)Approved in AdvanceYesNoBegin WorkLunch-OutLunch-InEnd WorkTotal HoursOfficial Action on Application (Return copy of signed Request to employee)Signature of Supervisor and DatePS Form 3971, march 2008 (Page 1 of 2)PSN 7530-02-000-9136 Pay Loc. #D/A CodeN/S DayDate SubmittedEmployee's Name (Last, First, )Installation (For PM leave, show city, state, and ZIP code)Time of Call or RequestScheduled Reporting Time Employee Can Be Reached At (If needed)No CallType of AbsenceDocumentation (For official use only)AnnualLWOP (See reverse)Other: Carrier 701 RuleRemarks (Do not enter medical information)For COP Leave (CA1 on file)For Advanced Sick Leave (1221 on file)For Military Leave (Orders reviewed)For Court Leave (Summons reviewed)For Higher Level (1723 on file)Scheme Training Testing, Qualifying (Memo on file)Employee's Signature and DateSignature of Supervisor and Date NotifiedSignature of Person Recording Absence and DateI understand that the annual leave authorized in excess of amount available to me during the leave year will be changed to :The furnis
PS Form 3971, March 2008 (Page 2 of 2) Leave Types (Information Only) CODES Leave Type Timecard Time Clock Annual – FMLA Sick – FMLA Sick - Dependent Care Absent Without Leave Act of God Blood Donor Civil Defense
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