AA - LEAVE REQUEST FORM - WALSH, EDWIN M.

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005388385
• 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: November 19, 1966

(Re ad Noia on Reverse Side)': !`a~V?L;i ~JOG"AV E.: REQUEST. ~ FORM
~ ,
ame-~, /`"/ . ~~~.5 (~ Ref. No. _. Department s~~~'-}' .~T Station %/~~A'/.
TYPE OF LEAVE
REQUESTED
FROM:_
NOUR DAY MONTH YEAR
THROUGH:
HOUR DAY MONTH YEAR
..,,TOTAL No.. OF,.
DAY HOUR
:Home ',
..
-Travel Time
Annual
d" / / 2 lPG4
! `~"' Z l
- 3i ck .,
;Without Pay (30.deys bbl eas)
(OTNERIL
~ `~? ~ ~ l 7L~e
- S ~ [,7
T 2' / ~k
S
~ /TJV~1
~
Address (and telep
ione No.) where employee can be reached while on leave:
1. Name of occupant of reside
ce, i. e.
%~
~
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JT l{~,~ ~,~0>V C~ ~>'~G/~/,G',
'/~C
n
2. Complete address ~~ ,.1~ ~/~
~~
/
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~+
if J ~! ~ ~ ,~ ~ ~~ / ~~~/' / ~.
' -- HO SE NO.,
aTR EET~
CITY, aTATE -
IF Ap ARTMENT( AL aO INDICATE Ap ARTMENT NO _. __._S'_.
-3. Tel ephone No. (if no telephone avail?abl e, so indi Cate),; ~''' '
Remhr)ts': a ~a.9 t ~----'_'"'
~- *,aoorued.lBap~
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Date: l
Employee's Signdture'
2 Ta Payiol] SecEion for'
_ Aecording/Action
N OV. 1 9._,196
Date ~-'~
Director of~
APPROVED FOR
RELEASEfI DATE:
24-Aug-2010
 MEDICAL CERTIFICATION "-' oaTE! ~. :,,;; > > n -.. (
THE CH6 EF OF MEDICPL DEPARTMENT OR DR. , COMPANY APPOINTED STAF F~PHYSICI AN,
HEREBY CERTIFI ESTHAT THE EMPLOYEE `C'ONCERNED-WAS-lOR WIL L~ B~EI -UNDER MED qC AL TR EAFMEN T; FRrQ'bi~
- ~- - -19_TO-- -- 19 _; 1NCLU~S trVE ~-AND-DI:IR ING'SUCH-`f'CME"'WfiS?'+
(IN GEN Efl AL TERMS ONIYI
SI GNATURE,OF CHIEF
t .n ( ,
I. EXCEPT FOR ANNUAL LEAVE OR LEAVE WITHOUT PAY INVOLVING DISCOUNTED TRAVEL ON OTHER CARRIERS; FOR-~
WHICH TWO COPIES OF THE REQUEST MUST BE SUBMITTED, ONLY ONE COPY (S NORMALLY REQUIRED IN THE
CASES. ALl LEAVE REQUESTS MUST BE SUBMITTED TO RECORDS SECTION OF PERSONNEL T3'I ~?15PON t10R HP~ O_I~E
MANAGER, TAINAN FOR CHINESE EMPLOYEES STATIONED AT TAINANI FOR APPftOV AL AND FURTHER ~{(~NDL,I N(r
2. FOR EMPLOYEES WHO DO NOT CLOCK TIME CARDS, ANOTHER EXTRA COPY EACH OF ALL .LEAVE REOIfE,S S>SR~1lU BE
RETAINED BY THE CONCERNED SUPERVISORS, .THE SUPERV b50R SHRLL''COMPLET E- RE TU`RM-TO DUTY1'REPORT`='017+-TI~'E
REVERSE SIDE OF THE EXTRA COPY AND SUBMIT SAME DIRECTLY TO RECORDS SECTION OF PERSONNEL DIVISION-OR
PER SONNEL MAN AGER ,7A1 NAN, AS APPROPRIATE, WHEN'THE EMPLOYEEsHAS R?TURNED ?TO ~DUTY:,OR~~I A;~, EA#hED';. TO
RETURN TA-DUTY-UPON-EXPIRAT I'ON DFTHE EMPLOYEE'S-APPROVED? EAVE. THE APPROVED `L EAVE DATES, 'IF
DIFFERENT FROM THE DATES ACTU qL LY-TAKEN, WILL BE AUTOMATICALLY AD.JU STE DjzeY RECORDS SECTION OF -
PERSONNEL DIVISION OR PERSONNEL MANAGER,TAINAN, BASING ON THE INFORMATION CONTAINED aOn TH'E `C,OMPL ETED
RETURN TODUTY-REPORT.. SUBMISSION OF_A REVISION-LEAVE REOU E:ST FOR TH IS PURPOSE IS NOT NECESSARY.
3. FOR EMPLOYEES WHO CLOCK TIME CARDS AND WHOSE APPROVED LEAVE DATES ARE DIFFERENT FROM TH. E.rDA.T ES
ACTUALLY TAKEN, A REVISION LEAVE REOU?ST MU STBE BUBMITTEDY70`SUPERSEDE-THE-OR-IGINAL"L PAVE ?R EOU ES?..:
4. REQUEST FO R~L.EAVE~WITHOUT PAY FOR A PERIOD OF OVER 30 DAYS MUST BE COVERED BY AN RPA FOR PRIOR
APPROVAL BY OIRECTOR'OF PERSONNEL. ~ ;r^^,u~Urv:9A~
RETURN TO DUTY REPORT - - - _ - ---
,' _ .'i)~
T0: PAYROLL SECTION VIA RECORDS SECTION, PND-TPE OR PERSONNEL MANAGER, TNN (CROSS OUT THE
INAPPLICABLE ONE1 ~~,
THIS IS -TO CONFIRM-TH ATTHE EMPLOYEE WHOSE'N AME-AND-REQUESTED-LEAVE-ARE-SHOWN ON THE OTHER ~~ OBE r.~`.--
k
-
,
q?~t
.w ..... ... a Der t..
AS SCHEDULED. ~\~.
___ _ a
HAS RETURNED TO DUTY ON ~~ WITH LEAVE DATES REVISED TO BE FROM
THROUGH _,.__ ?..._ -:,,.__._ _. ~~:. .-.__:.........
~~ ~fL(YE AflI .. ..kHOU RI - (DAYI= (MONTH) - FYEARI. '~' '~A^!