Fillable Form 1: LEAVE REQUEST/AUTHORIZATION OTHER. CAR TRAIN (Uniformed Services University Maryland)

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Form 1: LEAVE REQUEST/AUTHORIZATION OTHER. CAR TRAIN (Uniformed Services University Maryland)

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LEAVE REQUEST/AUTHORIZATION
NAVCOMPT FORM 3065 (3PT)(REV. 2-83)
INSTRUCTIONS FOR COMPLETING THIS FORM ARE
ON THE REVERSE OF PART 3
SEE REVERSE FOR
PRIVACY ACT
STATEMENT
1. DATE OF REQUEST
2. FOR ADMIN USE ONLY
APPROVAL OF THIS LEAVE IS
NOT VALID
WITHOUT CONTROL
LEAVE CONTROL NO.
3. SSN 4. NAME (Last, First, MI) 5. PAY GRADE
6. SHIP/STATION 7. DEPT/DIV 8. DUTY SECTION 9. DUTY PHONE
1
10. TYPE OF LEAVE
FOR USE OUTUS ONLY
12. MODE OF TRAVEL
REGULAR SICK EMERGENCY
11a. Leaving Area of P E R M D U T Y S T A
YES NO
AIR BUS
SEPARATION
RETIREMENT
OTHER.
11b. Taking Leave I N C O N U S
YES NO
CAR TRAIN
13. DAYS REQUESTED 14. FROM (Hour, Date) (YYMMDD) 15. TO (Hour, Date)(YYMMDD) 16. NORMAL WORKING HOURS
DAY OF DEPARTURE
FR
O
M: T
O
:
17. LEAVE BALANCE.
DAYS AS OF
.
18. LEAVE USED THIS
FY
19. LEAVE PHONE
DAY OF
RETURN
20. LEAVE ADDRESS FROM: TO:
21. RATION STAUS (Enlisted)
COMMUTED RATIONS
(COMRATS)
MEAL PASS NO.
Entitled to EDF meals except
during periods of leave
I CERTIFY THAT I HAVE SUFFICIENT FUNDS TO COVER THE COST OF ROUND TRIP TRAVEL.
I UNDERSTAND THAT SHOULD ANY PORTION OF THIS LEAVE, IF APPROVED, RESULTS IN MY
TAKING MORE LEAVE THAN I CAN EARN ON MY CURRENT UNEXTENDED ENLISTMENT OR
CURRENT ACTIVE DUTY OBLIGATION, MY PAY W ILL BE CHECKED FOR SUCH EXCESS LEAVE
SIGNATURE OF APPLICANT
RECOMMENDED DATE
YES NO
DATE
YES NO
DATE
YES NO
DATE
YES NO
23. APPROVED DISAPPROVED REVIEWING OFFICER’S NAME AND SIGNATURE DATE
YES NO
24. COMMENTS/REMARKS
25. SHIP OR STATION (Including telegraphic address) 26. REPORT ON EXPIRATION OF LEAVE TO (If other than block 25)
DEPARTED ON LEAVE RETURNED FROM LEAVE GRANTED EXTENSION OF LEAVE ENDING
27a. HOUR 27b. DATE (YYMMDD) 28a. HOUR 28b. DATE (YYMMDD) 29a. HOUR 29b. DATE (YYMMDD)
27c. OOD’S SIGNATURE
28c. OOD’S SIGNATURE
29c. OOD’S SIGNATURE
IN CONSIDERATION OF THE MEMBER’S COMPLETION OF A FULL
30. INCLUSIVE FIRST: LAST: 31. NO. OF
WORKDAY (AS DEFINED IN MILPERSMAN, NAVPERS 15560) ON THE DAYS OF
DEPARTURE AND RETURN, THE INCLUSIVE DAYS SHOWN ARE CORRECT
AND PROPER FOR CHARGING AS LEAVE.
LEAVE
PERIOD
TO BE
CHARGED
(YY) (MM
)
(DD) (YY) (MM
)
(DD) DAYS
I CERTIFY THAT THE ABOVE IS
CORRECT AND PROPER TO THE
BEST OF MY KNOWLEDGE
CERTIFYING OFFICER’S TYPE NAME/RANK/TITLE 33. CERTIFYING OFFICER’S SIGNATURE
WHITE COPY PINK COPY GREEN COPY
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Form 1: LEAVE REQUESTAUTHORIZATION OTHER. CAR TRAIN (Uniformed Services University Maryland)

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Completed 28 August 2020

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