Dmna Form 04 - Annual/personal Day Leave Request Form - New York State Military And Naval Affairs

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SAD ANNUAL/PERSONAL DAY LEAVE REQUEST FORM
STANDING
FROM:
MISSION:
SERVICE MEMBER NAME (Print Name)
PERSONAL DAY:
LEAVE TYPE: ANNUAL LEAVE:
RANK
Section 1: REQUESTED DATE(S) FOR ABSENCE / ACCRUAL BALANCES (before use of leave):
REQUESTED DATE(S) FOR ABSENCE:
ANNUAL LEAVE BALANCE:
PERSONAL DAYS BALANCE:
days
days
Section 2: COMMENTS:
COMMENTS: (Please provide additional information if requested by Command)
Section 3: CONTACT INFORMATION:
Please provide an address, phone number and any additional information necessary for command to contact you during your absence in the event of
an emergency National Guard response.
Section 4: REQUESTER SIGNATURE:
I am requesting to use (have used) SAD Annual leave and/or Personal day(s) leave as noted above in accordance with policy. I certify I
have sufficient leave accruals available to cover the requested absence. I understand utitilziation of a day with insufficient leave accruals
available will result in recoupment or being coded "N" (no duty status). I understand my request for the use of leave accruals can be
denied. I certify the information provided is true and accurate.
SERVICE MEMBER SIGNATURE
DATE
Section 5: APPROVER SIGNATURE/COMMENTS:
Approver will also verify sufficient leave accruals are available for service member:
o
o
Approved
Disapproved
COMMENTS:
APPROVING AUTHORITY SIGNATURE
DATE
APPROVING AUTHORITY NAME (Print Name)
RANK/TITLE
[SAD personnel staff must forward this document at the end of every payroll to JALC in accordance with Records Management procedures.]
Updated JUL/2017 (replaces JAN/2016)
DMNA Form 04
Page 1 of 1

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