NAVPERS Form 12600/3 "Bupers Civilian Employee Request for Extended Leave"

What Is NAVPERS Form 12600/3?

This is a legal form that was released by the U.S. Department of the Navy - Navy Personnel Command on February 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest available edition released by the U.S. Department of the Navy - Navy Personnel Command;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of NAVPERS Form 12600/3 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Navy - Navy Personnel Command.

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Download NAVPERS Form 12600/3 "Bupers Civilian Employee Request for Extended Leave"

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BUPERS CIVILIAN EMPLOYEE REQUEST FOR EXTENDED LEAVE
NAVPERS 12600/3 (02-2018)
Supporting Directive BUPERSINST 12600.5
INSTRUCTIONS:
1. Form must be FULLY completed. Forward original to the Civilian Pay Customer Service Representative (CSR).
2. BUPERSINST 12600.5 and BUPERS Civilian Leave Guide contain polices concerning non-routine leave requests.
It should be reviewed prior to requesting or recommending approval or disapproval of non-routine leave request.
Points To Be Considered
a. Effect of employee's absence on workload
b. Employee's leave record.
c. Seriousness of illness (in case of advance sick leave).
d. Use of accrued annual leave prior to advancing sick leave.
e. Probability of return to duty.
PART I: TO BE COMPLETED BY REQUESTING EMPLOYEE
1. Employee Name:
2. Phone Number:
3. Supervisor Name:
4. Department:
5. Activity UIC:
6. Period Covered:
Begin Date:
End Date:
Certification: I hereby request leave/approved absence from duty as indicated above and certify that such leave/absence is requested for purpose(s)
indicated. I understand that I must comply with my employing agency's procedures for requesting leave/approved absence (and provide additional
documentation, including medical certification, if required) and that falsification on this form my be grounds for disciplinary action, including removal.
7. Check type of leave requested and the number of hours for each type.
* Doctors statement must be attached stating nature of illness of incapacitation and dates employee cannot work.
Advance
Advance
Leave without pay
Any Leave
Annual Leave
Sick Leave*
in excess of 10 days
in excess of 30 days
Number of
Number of
Number of
Number of
Hours:
Hours:
Hours:
Hours:
This signature indicates that the above information is true and correct to my knowledge.
In requesting advance leave, my intention is to return to work to repay the amount of advance hours.
8. Employee Name:
9. Employee Signature:
10. Date:
PART II: SUPERVISORY RECOMMENDATION
Recommended
Not Recommended
1st Level Immediate Supervisor Name:
1st Level Immediate Supervisor Signature:
Date:
Recommended
Not Recommended
2nd Level Immediate Supervisor Name:
2nd Level Immediate Supervisor Signature:
Date:
PART III: TO BE COMPLETED BY BUPERS, WORKFORCE PLANNING AND PROGRAMS BRANCH (BUPERS-0532)
Sick Leave
Annual Leave
AWOL/LWOP
FMLA Invoke:
Balance (LS):
Balance (LA):
Hours Used:
PART IV: TO BE COMPLETED BY BUPERS, TOTAL FORCE HUMAN RESOURCES AND MANPOWER OFFICE (BUPERS-05)
Comments:
Approved
Disapproved
BUPERS-05 Representative Name:
BUPERS-05 Representative Signature:
Date:
FOR OFFICIAL USE ONLY
Page 1 of 1
PRIVACY SENSITIVE
BUPERS CIVILIAN EMPLOYEE REQUEST FOR EXTENDED LEAVE
NAVPERS 12600/3 (02-2018)
Supporting Directive BUPERSINST 12600.5
INSTRUCTIONS:
1. Form must be FULLY completed. Forward original to the Civilian Pay Customer Service Representative (CSR).
2. BUPERSINST 12600.5 and BUPERS Civilian Leave Guide contain polices concerning non-routine leave requests.
It should be reviewed prior to requesting or recommending approval or disapproval of non-routine leave request.
Points To Be Considered
a. Effect of employee's absence on workload
b. Employee's leave record.
c. Seriousness of illness (in case of advance sick leave).
d. Use of accrued annual leave prior to advancing sick leave.
e. Probability of return to duty.
PART I: TO BE COMPLETED BY REQUESTING EMPLOYEE
1. Employee Name:
2. Phone Number:
3. Supervisor Name:
4. Department:
5. Activity UIC:
6. Period Covered:
Begin Date:
End Date:
Certification: I hereby request leave/approved absence from duty as indicated above and certify that such leave/absence is requested for purpose(s)
indicated. I understand that I must comply with my employing agency's procedures for requesting leave/approved absence (and provide additional
documentation, including medical certification, if required) and that falsification on this form my be grounds for disciplinary action, including removal.
7. Check type of leave requested and the number of hours for each type.
* Doctors statement must be attached stating nature of illness of incapacitation and dates employee cannot work.
Advance
Advance
Leave without pay
Any Leave
Annual Leave
Sick Leave*
in excess of 10 days
in excess of 30 days
Number of
Number of
Number of
Number of
Hours:
Hours:
Hours:
Hours:
This signature indicates that the above information is true and correct to my knowledge.
In requesting advance leave, my intention is to return to work to repay the amount of advance hours.
8. Employee Name:
9. Employee Signature:
10. Date:
PART II: SUPERVISORY RECOMMENDATION
Recommended
Not Recommended
1st Level Immediate Supervisor Name:
1st Level Immediate Supervisor Signature:
Date:
Recommended
Not Recommended
2nd Level Immediate Supervisor Name:
2nd Level Immediate Supervisor Signature:
Date:
PART III: TO BE COMPLETED BY BUPERS, WORKFORCE PLANNING AND PROGRAMS BRANCH (BUPERS-0532)
Sick Leave
Annual Leave
AWOL/LWOP
FMLA Invoke:
Balance (LS):
Balance (LA):
Hours Used:
PART IV: TO BE COMPLETED BY BUPERS, TOTAL FORCE HUMAN RESOURCES AND MANPOWER OFFICE (BUPERS-05)
Comments:
Approved
Disapproved
BUPERS-05 Representative Name:
BUPERS-05 Representative Signature:
Date:
FOR OFFICIAL USE ONLY
Page 1 of 1
PRIVACY SENSITIVE