AA - LEAVE REQUEST - WALSH, EDWIN M.

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005388347
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 23, 2015
• Document Release Date: September 9, 2010
• Case Number: F-2009-00749
• Publication Date: September 25, 1969

(3~716t-
PERSONNEL DIVISION
LEAVE REQUEST
NAME
#i /Ut.
EMPLOYEE No.
"57 ~ 3 r
DEPARTMENT/DIVISION
o r S1?D T'-l
BASE/STATION
/'' jv
FROM
THROUGH
TOTAL No. OF
TYPE OF LEAVE REQUESTED
HOUR DAY MONTH YEAR
HOUR DAY MONTH YEAR
DAY
HOUR
HOME
TRAVEL TIME
,NNUAL VACATION
ANNUAL
~}e~
2~4 le
v
.
Lye-
SICK
SICK
WITHOUT PAY (30 DAYS
OR LESS)
(OTHER)
ADDRESS (AND TELEPHONE No.) WHERE EMPLOYEE CAN -BE REACHED
L. C. C/O
1. NAME OF?CCy
A lF//`,{t ES I BENCE.
Y//
!/
WHILE ON LEA
V :
_
jR
A Q;P~R E'S
(8011SE N O.. S EELS /CITY, ,/, SATE ZIP OD/-
? YE
z
o,
17
J
LN/
IF pp SR TMENT
jK'
4l 50
AVAILABLE, SO INDICATE)
NO. (IF NO
TELEPHONE
3.
TELEPHONE
4. NAME OF CARRIER TO USA (TO BE COMPLETED BY EMPLOYEES PROCEEDING TO USA ON ANY TYPE OF LEAVE)
EMPLOYEE'S-SIGNATURE: a
DIVISION DIRECTOR
OFFICER
DIRECTOR OF
NAME
PERSONNEL
APPROVALS
TITLE
A// J~
HP
7 L C
DATE
SEA 3 0 5J4'~
,~ l',
ROUTING
INITIALS
DATE EMP:
REMARKS
D, ACCURED LEAVE
UNU O
I. TO PERSONNEL DIVISION FOR APPROVAL
C /l
F
2. TO PAYROLL DEPARTMENT FOR
S/L: DAYS
RECORDING/ACTION
A/L: DAYS
H/L: DAYS
3. TO PERSONNEL DIVISION FOR FILE
AVL: DAYS
APPROVED FOR
RELEASE] DATE:
24-Aug-2010
 MEDICAL CERTIFICATION DATE:
THE CHIEF OF MEDICAL DEPARTMENT OR DR. COMPANY APPOINTED STAFF PHY.VICIAN,
HERtSY CERTIFIES THAT THE EMPLOYEE CONCERNED WAS (OR WILL BE).UNDER MED I CAL TREATMENT FROM
19_TO , 19_, INCLUSIVE, AND DURING SUCH TIME WAS
(OR WILL BE) INCAPACITATED FOR REGULARLY ASSIGNED'DUTIES.
NATURE OF DISABILITY:
IN GENERAL TERMS ONLY).
SIGNATURE OF CHIEF MEDICAL DEPARTMENT OR ATTENDING PHYSICIAN:
NOTE
1. TWO (2) COPIES OF THIS LEAVE REQUEST SHOULD BE SUBMITTED TO THE PERSONNEL DIVISION FOR LEAVE OF ANY
TYPE WHICH INVOLVES TRAVEL TO THE USA. ONE (1) COPY OF THIS LEAVE REQUEST SHOULD BE SUBMITTED FOR
LEAVE OF ANY TYPE WHICH DOES NOT INVOLVE SUCH TRAVEL. ALL LEAVE REQUESTS MUST BE SUBMITTED TO
RECORDS SECTION OF PERSONNEL DIVISION (OR CHIEF OF PERSONNEL DEPARTMENT-TA I NAN FOR CHINESE EMPLOYEES
STATIONED AT TAINAN) FOR APPROVAL AND FURTHER HANDLING.
2. ONE (1) COPY OF THIS LEAVE REQUESTMUST BE RETAINED BY THE SUPERVISOR OF EMPLOYEES WHO DO NOT CLOCK
TIME CARDS. THE SUPERVISOR SHALL COMPLETE RETURN TO DUTY REPORT ON THE REVERSE SIDE OF SUCHCOPY
AND SUBMIT SAME DIRECTLY TO RECORDS SECTION OF PERSONNEL DIVISION OR CHIEF OF PERSONNEL DEPARTMENT-
TAINAN, AS APPROPRIATE, WHEN THE EMPLOYEE HAS. RETURNED TO DUTY OR HAS FAILED TO RETURN TO DUTY UPON
EXPIRATION OF THE EMPLOYEE'S APPROVED LEAVE. THE APPROVED LEAVE DATES, IF DIFFERENT FROM TH DATES
ACTUALLY TAKEN, WILL BE AUTOMATICALLY ADJUSTED BY RECORDS SECTION OF PERSONNEL DIVISION OR CHIEF OF
PERSONNEL DEPARTMENT-TAINAN,BASED ON THE INFORMATION CONTAINED IN THE COMPLETED RETURN TO DUTY
REPORT. SUBMISSION OF A REVISION LEAVE REQUEST FOR THIS PURPOSE IS NOT NECESSARY.
3. FOR EMPLOYEES WHO CLOCK TIME CARDS AND WHOSE APPROVED LEAVE DATES ARE DIFFERENT FROM 'THE DATES
ACTUALLY TAKEN, A REVISION LEAVE REQUEST MUST BE SUBMITTED TO SUPERSEDE THE ORIGINAL LEAVE'REQUEST.
4. REQUEST FOR LEAVE WITHOUT PAY FOR A PERIOD OF OVER 30 DAYS MUST BE COVERED BY AN RPA FOR PR-IOR
APPROVAL BY DIRECTOR OF PERSONNEL.
RETURN TO DUTY REPORT
PAYROLL DEPARTMENT VIA RECORDS SECTION, PND-TPE OR CHIEF, OF PERSONNEL DEPARTMENT-TNN (CROSS
OUT THE INAPPLICABLE ONE)
HAS RETURNED TO DUTY ON AS SCHEDULED.
HAS RETURNED TO DUTY ON WITH REVISED LEAVE DATES AS
INDICATED ON THE OTHER SIDE.
HAS FAILED TO RETURN TO DUTY UPON EXPIRATION OF HIS REQUESTED LEAVE.
SUBMITTED WHEN HE RETURNS FROM THE LEAVE.