110TH Military Police Company Guard

1
110TH Military Police Company (Guard) LEAVE /
PASS Request Form
Submit this form to the Operations Sergeant with
copy of most recent LES attached. If soldier is
driving also attach strip map, driving plan to
include rest breaks, POV inspection checklist and
Leave Safety Counseling The Commander will
Approve or Disapprove before the DA 31 is
prepared. Once the request is approved, a DA 31
will be prepared and sent back to the requesting
soldier and first line supervisor for signature.
Under normal circumstances, request for LEAVE /
PASS will be submitted to the Orderly Room a
minimum of 14 days from the requested LEAVE /
PASS date. DO NOT SUBMIT FURTHER THAN 30 DAYS
OUT! All personnel, SSG and below will come to
the CQ or Orderly Room to physically sign in and
out on LEAVE / Pass. SFC and above, are
authorized to call to sign in or out on LEAVE and
PASS.
LEADERSHIP APPROVAL Printed Name
Initials Date Recommendation
SQUAD LEADER
_____________ _______
____________ YES
NO PLATOON SERGEANT _____________
_______ ____________
YES NO PLATOON LEADER
_____________
_______ ____________
YES NO OPERATION SERGEANT
_____________ _______
____________ YES NO
FIRST SERGEANT _____________
_______ ____________
YES NO COMMANDER
______________
_______ ____________
YES NO