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Military Spouse Leave Request Form: A. Personal Information

This document is a military spouse leave request form for an employee to request time off when their spouse is on leave from deployment during a period of military conflict. The form requires the employee to provide personal information and details about their spouse's military status and leave dates in order to determine eligibility for unpaid leave, though paid vacation or personal time can be used. The employee must get supervisor approval and then submit the completed form to human resources for final action and determination.

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Fernado Gomez
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156 views1 page

Military Spouse Leave Request Form: A. Personal Information

This document is a military spouse leave request form for an employee to request time off when their spouse is on leave from deployment during a period of military conflict. The form requires the employee to provide personal information and details about their spouse's military status and leave dates in order to determine eligibility for unpaid leave, though paid vacation or personal time can be used. The employee must get supervisor approval and then submit the completed form to human resources for final action and determination.

Uploaded by

Fernado Gomez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Human Resources

Military Spouse Leave Request Form


A. Personal Information
Name: Program/Department: Employee ID#: Date:

B. Eligibility

Please check all that apply:

I am regularly scheduled to work a minimum of 20 hours per week.

My spouse is a qualified member of the United States Armed Forces, National Guard or Reserves.

My spouse has been deployed for active duty (a) as a member of the U.S. Armed Forces during a period of military conflict to an
area designated as a combat theater or combat zone by the U.S. President, or (b) as a member of the National Guard or Reserves
during a period of military conflict.

I have received official notice certifying that my spouse will be on leave from deployment during a period of military conflict
(Please attach a copy of the official notice to this form.)

• Date official notice was received: ________________________

• Dates of spouse’s leave from deployment: ________________________ to ________________________

C. Duration of Leave

I am requesting _______________ days of leave during my spouse’s leave from deployment for the following dates:

________________________ to ________________________

D. Employee Request

I understand this leave is unpaid unless I have available vacation or personal time.

I am requesting to use available vacation/personal time during my leave.

___________________________________________________________ _____________________________
Employee Signature Date

___________________________________________________________ _____________________________
Supervisor Signature Date

E. Trust Human Resources Action

Approved
Denied (provide explanation)

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

___________________________________________________________ _____________________________
HR Specialist Signature Date

October 2007

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