Form 552-0798 "Request for Military Leave Dates" - Iowa

What Is Form 552-0798?

This is a legal form that was released by the Iowa Department of Administrative Services - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2019;
  • The latest edition provided by the Iowa Department of Administrative Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 552-0798 by clicking the link below or browse more documents and templates provided by the Iowa Department of Administrative Services.

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Download Form 552-0798 "Request for Military Leave Dates" - Iowa

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REQUEST FOR MILITARY LEAVE DATES
Date:
_____________________________________
To:
___________________________
Re:
Verification of Military Service Dates
It is State of Iowa policy to facilitate the military activities of our employees and to comply with the
Uniformed Services Employment and Reemployment Rights Act of 1994, as amended.
__________________________________, an employee of __________________________________
(Name)
(Agency)
has notified his/her supervisor of the need to be absent from work due to necessary military duty on the
following dates:
Reported Dates:
________________ To ________________
(Beginning date)
(Ending date)
Corrected Dates(if applicable):
________________ To ________________
(Beginning date)
(Ending date)
If this information is correct, please sign and return this form.
If this information is incorrect, please provide the correct military duty dates and return this form.
We appreciate your attention to this memo.
Return to:
Military Representative:
______________________________________
______________________________________
(Signature of Authorized Representative)
(Signature of Military Representative)
______________________________________
______________________________________
(Name and Title)
(Name of Sr. NCO or Officer and Rank)
______________________________________
______________________________________
(Agency)
(Branch of Service)
______________________________________
______________________________________
(Agency Street Address)
(Unit Street Address)
______________________________________
______________________________________
(City, State, Zip Code)
(City, State, Zip Code)
552-0798 01/2019
1
REQUEST FOR MILITARY LEAVE DATES
Date:
_____________________________________
To:
___________________________
Re:
Verification of Military Service Dates
It is State of Iowa policy to facilitate the military activities of our employees and to comply with the
Uniformed Services Employment and Reemployment Rights Act of 1994, as amended.
__________________________________, an employee of __________________________________
(Name)
(Agency)
has notified his/her supervisor of the need to be absent from work due to necessary military duty on the
following dates:
Reported Dates:
________________ To ________________
(Beginning date)
(Ending date)
Corrected Dates(if applicable):
________________ To ________________
(Beginning date)
(Ending date)
If this information is correct, please sign and return this form.
If this information is incorrect, please provide the correct military duty dates and return this form.
We appreciate your attention to this memo.
Return to:
Military Representative:
______________________________________
______________________________________
(Signature of Authorized Representative)
(Signature of Military Representative)
______________________________________
______________________________________
(Name and Title)
(Name of Sr. NCO or Officer and Rank)
______________________________________
______________________________________
(Agency)
(Branch of Service)
______________________________________
______________________________________
(Agency Street Address)
(Unit Street Address)
______________________________________
______________________________________
(City, State, Zip Code)
(City, State, Zip Code)
552-0798 01/2019
1
REQUEST FOR MILITARY LEAVE DATES
Understanding the Need to Verify Military Orders
The Administrative Rule, 11- 63.9(8A) Military Leave, subrules 63.9(1) and 63.9(3) specifies an employee
is granted leave without loss of pay for 30 days each calendar year “when ordered by proper authority
to uniformed services” or “when ordered by proper authority to military duty.” The Uniformed Services
Employment and Reemployment Rights Act (USERRA), 38 U.S.C. sections 4301-4333, and 20 CFR Part
1002, set forth the various standards regarding re-employment of veterans including employer notice of
the call to duty.
Since the Administrative Rule requires the leave without loss of pay (Military Leave w/Pay) may only be
afforded the soldier when the call to duty is by proper authority, verification of military orders may at
times be necessary. For this purpose, The Department of Administrative Services - Human Resources
Enterprise is providing the attached memorandum to be used when an agency deems it necessary to
confirm military duty dates in order to authorize Military Leave w/Pay.
552-0798 01/2019
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