Dd Form 2540 - Voluntary Leave Transfer Program Notice Of Termination Of Medical Emergency

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1. PAYBLOCK NUMBER
VOLUNTARY LEAVE TRANSFER PROGRAM
NOTICE OF TERMINATION OF MEDICAL EMERGENCY
2. LEAVE RECIPIENT
a. NAME (Last, First, Middle Initial)
b. SOCIAL SECURITY NO.
c. ORGANIZATION
4. DATE OF TERMINATION OF
3. LEAVE DATA
MEDICAL EMERGENCY
a. DATE TRANSFERRED LEAVE
b. NUMBER OF HOURS OF
c. NUMBER OF HOURS OF
(YYMMDD)
BEGAN (YYMMDD)
LEAVE TRANSFERRED
TRANSFERRED LEAVE USED
5. REMARKS
6. SUPERVISOR CERTIFICATION
a. SIGNATURE
b. DATE SIGNED (YYMMDD)
COPY TO:
EMPLOYEE (LEAVE RECIPIENT)
CIVILIAN PERSONNEL OFFICE
COMPONENT ADMINISTRATIVE/EXECUTIVE OFFICER
CIVILIAN PAYROLL OFFICE
DD FORM 2540, MAY 89
Adobe Professional X

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