LEAVE REQUEST/AUTHORIZATION SEE PAGE 2 FOR

INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON PAGE 2. PRIVACY ACT

NAVCOMPT 3065 (REV. 01/2007) STATEMENT
1. DATE OF REQUEST 2. FOR ADMIN. USE ONLY
APPROVAL OF THIS LEAVE IS
NOT VALID WITHOUT CONTROL NO.
LEAVE CONTROL NO. ►
3. SSN 4. NAME (Last, First, MI) 5. PAYGRADE

6. SHIP/STATION 7. DEPT/DIV 8. DUTY SECTION 9. DUTY PHONE

10. TYPE LEAVE FOR USE OUTUS ONLY 12. MODE OF TRAVEL
11a. Leaving Area of PERMDUTYSTA AIR
REGULAR SICK EMERGENCY BUS
YES NO
11b. Taking Leave INCONUS CAR TRAIN
SEPARATION RETIREMENT OTHER
YES NO
13. DAYS REQUESTED 14. FROM (Hour, Date) (YYMMDD) 15. TO (Hour, Date) (YYMMDD) 16. NORMAL WORKING HOURS
DAY OF DEPARTURE:
FROM: TO:
17. LEAVE BALANCE 18. LEAVE USED THIS FY 19. LEAVE PHONE
DAY OF RETURN:
DAYS AS OF FROM: TO:
20. LEAVE ADDRESS
21. RATION STATUS (Enlisted)
COMMUTED RATIONS (COMRATS)
Meal Pass No.
Entitled to EDF meals except
during periods of leave

I CERTIFY THAT I HAVE SUFFICIENT FUNDS TO COVER THE COST OF ROUND TRIP TRAVEL. I UNDERSTAND 22. SIGNATURE OF APPLICANT
THAT SHOULD ANY PORTION OF THIS LEAVE, IF APPROVED, RESULT IN MY TAKING MORE LEAVE THAN I CAN
EARN ON MY CURRENT UNEXTENDED ENLISTMENT OR CURRENT ACTIVE DUTY OBLIGATION, MY PAY WILL BE
CHECKED FOR SUCH EXCESS LEAVE.
RECOMMENDED DATE
YES NO

DATE
YES NO

DATE
YES NO

DATE
YES NO

23. APPROVED DISAPPROVED REVIEWING OFFICER'S NAME AND SIGNATURE DATE

24. COMMENTS/REMARKS

25. SHIP OR STATION (Including telegraphic address) 26. REPORT ON EXPIRATION OF LEAVE TO (If other than block 25)

DEPARTED ON LEAVE RETURNED FROM LEAVE GRANTED EXTENSION OF LEAVE ENDING

27a. HOUR 27b. DATE (DD MMM YYYY) 28a. HOUR 28b. DATE (DD MMM YYY) 29a. HOUR 29b. DATE (DD MMM YYYY)

27c. OOD'S SIGNATURE 28c. OOD'S SIGNATURE 29c. AUTHORIZING OFFICER'S SIGNATURE

FIRST: LAST: 31. NO.

IN CONSIDERATION OF THE MEMBER'S COMPLETION OF A FULL WORKDAY 30. INCLUSIVE OF
(AS DEFINED IN MILPERSMAN, NAVPERS 15560) ON THE DAYS OF DEPARTURE
AND RETURN, THE INCLUSIVE DAYS SHOWN ARE CORRECT AND PROPER FOR
LEAVE PERIOD
TO BE ► (YY) (MM) (DD) (YY) (MM) (DD)
DAYS

CHARGING AS LEAVE. CHARGED

I CERTIFY THAT THE ABOVE IS 32. CERTIFYING OFFICER'S TYPED NAME/RANK/TITLE 33. CERTIFYING OFFICER'S SIGNATURE
CORRECT AND PROPER TO THE
BEST OF MY KNOWLEDGE.

FORWARD A COPY TO PERSONNEL OFFICE VIA COMMAND ONLY ON COMPLETION OF LEAVE.

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IMPORTANT THIS IS YOUR "OFFICIAL" LEAVE AUTHORIZATION.
NOTICE !! DO NOT DESTROY OR LOSE!
1. Leave is granted subject to immediate recall, therefore maintain communication with your leave address. Keep this leave
authorization in your possession at all times. In the event of a general recall, individual orders may not be issued. Inform your
commanding officer of permanent change of leave address.
2. Save sufficient money or obtain round-trip ticket to insure you have return transportation. Keep yourself informed of transportation
schedules and weather conditions through your return route and make sufficient allowances for normal delays.
3. While it is desirable to tell the public about your Navy, do not discuss any subject unless you are certain it is unclassified. If you are
asked to participate in a press conference, talk to reporters, or speak over the radio or television on matters pertaining to the naval
service, and you are not certain that all your remarks are unclassified, consult with and obtain guidance of the commanding officer
of the nearest naval unit prior to participation.
4. Cooperate with Military or Air Police, Shore Patrol, and civil authorities at all times. You are subject to orders of your superior
officers in all branches of the U.S. Armed Forces. Be an outstanding Navy ambassador at all times.
5. If necessary to request an extension of leave, communicate with your commanding officer by telegram. SINCE YOU NEED
POSITIVE APPROVAL FOR REMAINING ABSENT BEYOND THE TIME ORIGINALLY AUTHORIZED, IF NO REPLAY IS
RECEIVED YOU MUST CONSIDER YOUR REQUEST NOT APPROVED.
6. In case of serious illness or injury incurred while on leave which requires medical attention or hospitalization, report facts to your
commanding officer. If in the immediate vicinity of a naval activity, such as recruiting station or naval station, advise them of your
condition and status. You are advised that costs incident to hospitalization or medical treatment received at other than Federal
medical activities (Army, Air Force, Public Health Service, or Veterans' Administration) may be defrayed by the Navy Department in
EMERGENCY cases only.
7. In the event that conditions beyond your control indicate late return to the command to which you are ordered to report, obtain
written evidence from transportation agency or others (physician, military or civil police, recruiting station, etc.) for consideration by
your commanding officer.
8. Request leave sufficiently in advance to allow processing via official channels. Leave is computed as follows: The day of departure
on leave, shall be counted as a day of duty, except when leave commences prior to the end of the normal workday; the day of
return from leave shall be counted as a day of leave, except when such return is made at or before commencement of your normal
workday in which case it shall be counted as a day of duty.
OPERATION DRIVESAFE REMINDER
Statistics show the major causes of motor vehicle accidents are attributable to:
Excessive speed
Intoxicating liquor, and
Driving while fatigued or sleepy.
PLAN YOUR TRIP CAREFULLY. Be sure you allow yourself sufficient travel time and keep your travel to a minimum during
hours of darkness.
INSTRUCTIONS FOR COMPLETING THE LEAVE REQUEST PORTION OF THIS FORM
1. Completion of this form must be in ballpoint or typewriter. The form must be completed in triplicate with all copies egible.
2. Print or type the appropriate data in blocks 1, and 3 through 21. Leave block 2 blank.
3. When completing blocks 14 and 15, follow these rules:
a. Block 14 - The hour for starting leave may not be prior to the end of your normal workday if leave starts on a workday. If leave
starts ona non-workday, the starting hour may be 0001 if not contrary to command policy.
b. Block 15 - The hour for ending leave may not be later than the beginning of your normal workday if the day of return is a
workday. If leave ends on a non-workday, the ending hour may be 2400 if not contrary to command policy.
4. Block 16 requires the following information:
Normal working hours for day of departure.
Normal working hours for day of return.
If day of departure or return is not a workday, enter "NONE"
5. Information required in blocks 17 and 18 may be obtained from Block 59 of your latest Leave and Earnings Statement or from your
activity's Commanding Officer's Leave Listing.
6. You are advised that you must immediately return your original leave authorization to the appropriate office designated by your
command upon return from leave.
PRIVACY ACT STATEMENT
This statement is provided in compliance with the provisions of the Privacy Act of 1974 (PL 93-579) which require that Federal
agencies must inform individuals who are requested to furnish information about themselves as to the following facts concerning the
information requested.
1. AUTHORITY: Title 10 and 37 USC.
2. PRINCIPAL PURPOSE(S): To authorize military leave of absence.
3. ROUTINE USE(S): To deduct leave taken from member's accrued leave balance. To pay leave rations to enlisted members.
4. MANDATORY OR VOLUNTARY DISCLOSURE: Voluntary. If the member does not request a specific period of leave and furnish
his leave address, leave is not granted.
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