Ridgefield Fire Department
MILITARY LEAVE REQUEST FORM
Today’s Date: _______/_______/_______
Name: _____________________________________
Shift: ___________
Type of Military Leave Requested: _________________________________________
Military Date(s) Requested:
Start Date: ______/______/______
Time: ______:______
End Date: ______/______/______
Time: ______:______
Please include a copy of any orders for Military Leave
_____________________________________
_______/_______/_______
Approved By
Date
Notes:
______________________________________________________________________
______________________________________________________________________
Updated: 05/01/2013
Ridgefield Fire Department
MILITARY LEAVE REQUEST FORM
Today’s Date: _______/_______/_______
Name: _____________________________________
Shift: ___________
Type of Military Leave Requested: _________________________________________
Military Date(s) Requested:
Start Date: ______/______/______
Time: ______:______
End Date: ______/______/______
Time: ______:______
Please include a copy of any orders for Military Leave
_____________________________________
_______/_______/_______
Approved By
Date
Notes:
______________________________________________________________________
______________________________________________________________________
Updated: 05/01/2013
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