DIY Legal Forms

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Military Duty Absence


[Mr/Mrs/Ms/Dr] [First Name] [Last Name]




[City] [State] [Zip]

Dear [Mr/Mrs/Ms/Dr] [Last Name]:

The undersigned hereby requests absence or leave from my employment for purposes of temporary active military duty from [Date], to [Date].

I certify that I am a member of the [Name], I understand that if my military base pay ior this period is less than my regular salary, I will be reimbursed for the diiference for a period not to exceed [--] work weeks [--] days.

I further agree to furnish you a copy of my military pay statement immediately upon receipt with adjustments in salary to be made from my next paycheck.

Furthermore, I agree to furnish the [Company] a copy of my orders to report for service or such other appropriate certification of duty as the Company may require.


Name of Employee

This Section for Notary:


STATE OF -------)

) ss: [Date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.


[Name of Notary Public]

My commission expires: [date]