DEPARTMENT OF THE ARMY
REQUEST AND AUTHORIZATION FOR LEAVE/PASSRequests for LEAVE/PASS will be submitted for the Commander’s approval at least 14 days prior to the anticipated departure date for leave and 7 days prior for passes. This cover sheet, the most current LES, and DA Form 31 are required for this packet. All soldiers in the rank of SSG and below must sign in and out at the Staff Duty desk and carry a copy of the DA Form 31. All E-7 and above may call in to sign in or out.REQUEST DATE: ________________________ PLT: _____________________________RANK/NAME: ________________________________________ SSN: _____________________________CIRCLE ONE:TDY | LEAVE | PASS | MILEAGE PASS REASON: _________________________________________START: _________________ TOTAL # DAYS: _______ END: ________________ DAYS ACCRUED: ________ LEAVE/PASS ADDRESS: ________________________________________________________________________________ LEAVE/PASS PHONE #: _________________________________________________________________________________ I understand I must sign in by midnight on the last day of leave. Failure to do so without proper authorization by the Chain of Command may result in UCMJ Action.SOLDIERS SIGNATURE: ________________________________________________________________________COMMENTS: __________________________________________________________________________________SECTION NCOIC: ______________________ SIGNATURE: ____________________ DATE: ______________ LES: _______ ERB: _______POV INSPECTION: ______ RISK ASSESSMENT: _____ TA50 INSPECTION: _____FLAG YES/NO: _______ CLS: _______ DRIVERS TRAINING COURSE: ______ MEDPRO GO/NOGO: _________COMMENTS: ___________________________________________________________________________________PLATOON SERGEANT: ___________________________SIGNATURE: _______________ DATE: ______________ DA FORM 31:_______ DA FORM 4856:_______ PROFILE: ______EST GO/NOGO: ______ ERB: ___________PT TEST GO/NOGO: _______ LAST PT TEST: _______ ROAD MARCH: ______ EST GO/NOGO: ____________COMMENTS: ___________________________________________________________________________________ORDERLY ROOM REP: _____________________ SIGNATURE/DATE RECEIVED: _________________________COMMENTS: ___________________________________________________________________________________FIRST SERGEANT: __________________________________ DATE SIGNED: ______________________________COMMENTS: ___________________________________________________________________________________ ................
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