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    Special Request Chit

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    Meloyfello
    An individual is requesting special leave or authorization from the Navy. The form collects personal information such as name, rate, social security number, duty station, and nature of the request which can include special leave, special liberty, commuted rations, or other. The applicant provides details of the request including dates, travel plans, and reason. Supervisors must sign to recommend approval or disapproval and provide their rank, title and date. The final decision is also recorded on the form as approved or disapproved.

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    Download as PDF, TXT or read online from Scribd

    Special Request Chit

    Uploaded by

    Meloyfello
    2K views1 page
    An individual is requesting special leave or authorization from the Navy. The form collects personal information such as name, rate, social security number, duty station, and nature of the request which can include special leave, special liberty, commuted rations, or other. The applicant provides details of the request including dates, travel plans, and reason. Supervisors must sign to recommend approval or disapproval and provide their rank, title and date. The final decision is also recorded on the form as approved or disapproved.

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    An individual is requesting special leave or authorization from the Navy. The form collects personal information such as name, rate, social security number, duty station, and nature of the request which can include special leave, special liberty, commuted rations, or other. The applicant provides details of the request including dates, travel plans, and reason. Supervisors must sign to recommend approval or disapproval and provide their rank, title and date. The final decision is also recorded on the form as approved or disapproved.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2K views1 page

    Special Request Chit

    Uploaded by

    Meloyfello
    An individual is requesting special leave or authorization from the Navy. The form collects personal information such as name, rate, social security number, duty station, and nature of the request which can include special leave, special liberty, commuted rations, or other. The applicant provides details of the request including dates, travel plans, and reason. Supervisors must sign to recommend approval or disapproval and provide their rank, title and date. The final decision is also recorded on the form as approved or disapproved.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    SPECIAL REQUEST/AUTHORIZATION

    NAVPERS 1336/3 (Rev. 9-75)


    SIN 106-LF-063-8633
    PRIVACY ACT STATEMENT
    The authority to request this information is contained in 5 USC employees of the Department of the Navy in determining your
    301, Departmental Regulations. The principal purpose of the in- eligibility for and approving or disapproving the special considera-
    formation is to enable you to make known your desire for one tion or authorization being requested. Completion of the form is
    of the four name listed or for some other special consideration or mandentory; failure to provide required information may result in
    authorization. The information will be used to assist officals and delay in response to or disapproval of your request. _

    NAME RATE SSN

    SHIP OR STATION DATE OF REQUEST

    DEPARTMENT / DIVISION / WARD DUTY SECTION / GROUP

    NATURE OF REQUEST
    SPECIAL SPECIAL COMMUTED OTHER
    LEAVE PAY
    LIBERTY RATIONS (Below)
    NO. DAYS REQUEST FROM (Date and Time) TO (Date and Time)

    DISTANCE (Miles) MODE OF TRAVEL

    AIR TRAIN BUS CAR

    LEAVE ADDRESS (Street, box Or route number., City, State, Zip Code) TELEPHONE NUMBER

    REASON FOR REQUEST

    SIGNATURE OF APPLICANT:

    I AM ELIGIBLE AND OBLIGATE MYSELF TO PERFORM ALL DUTIES OF PERSON MAKING APPLICATION -
    SIGNATURE OF STANDBY DUTY STATION

    PERSONNEL OFFICE
    EARNED LEAVE LEAVE THIS FISCAL YEAR DATE LAST PAID

    DAYS AS OF:

    RECOMMENDED APPROVAL SIGNATURE AND RANK / RATE / TITLE / DATE

    YES NO

    SIGNATURE AND RANK / RATE / TITLE / DATE


    YES NO

    SIGNATURE AND RANK / RATE / TITLE / DATE


    YES NO

    SIGNATURE AND RANK / RATE / TITLE / DATE


    YES NO

    SIGNATURE
    APPROVED DISAPPROVED

    REASON FOR DISAPPROVAL

    LOG OUT AND IN WITH OOD (When required)


    OUT (Hour and date) INITIALS 00D IN (Hour and date) INITIALS 000

    HITCHHIKING IS PROHIBITED • U.S.GPO:1994-505-188

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