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RECOMMENDED APPROVAL YES DATE RANK/RATE/TITLE SIGNATURE NO APPROVED 22. REASON FOR DISAPPROVAL NAVPERS 1336/3 Rev. 02-2011 FOR OFFICIAL USE ONLY - PRIVACY SENSITIVE Reset Form Print Form. SPECIAL REQUEST/AUTHORIZATION SUPPORTING DIRECTIVE MILPERSMAN ARTICLES 1810-010 AND 1810-040 PRIVACY ACT STATEMENT THE AUTHORITY TO REQUEST THIS INFORMATION IS CONTAINED IN 5 USC 301. THE PRINCIPLE PURPOSE OF THE INFORMATION IS TO ENABLE YOU TO MAKE KNOWN YOUR DESIRE FOR ITEMS LISTED OR FOR SOME OTHER SPECIAL CONSIDERATION OR AUTHORIZATION* THE INFORMATION WILL BE USED TO ASSIST OFFICIALS AND EMPLOYEES OF THE DEPARTMENT OF THE NAVY IN DETERMINING YOUR ELIGIBILITY FOR AND APPROVING OR DISAPPROVING THE SPECIAL CONSIDERATION OR AUTHORIZATION BEING REQUESTED. COMPLETION OF THE FORM IS MANDATORY FAILURE TO PROVIDE REQUIRED INFORMATION MAY RESULT IN DELAY IN RESPONSE TO OR DISAPPROVAL OF YOUR REQUEST. 1. NAME 2. RATE 3. SHIP OR STATION 4. DATE OF REQUEST YYYYMMDD 5. DEPARTMENT/DIVISION 6. DUTY SECTION/GROUP 7. NATURE OF REQUEST SPECIAL LIBERTY LEAVE 8. NO. OF DAYS REQUESTED FROM DATE AND TIME 9. DISTANCE MILES MODE OF TRAVEL COMMUTED RATIONS OTHER BELOW CAR AIR 10. LEAVE ADDRESS TRAIN BUS 11. TELEPHONE NUMBER 12. REASON FOR REQUEST 13. SIGNATURE OF APPLICANT Use CAC for digital signature SIGNATURE OF STANDBY 14. I am eligible and obligate myself to DUTY STATION perform all duties of person making application* 15. SPECIAL REQUEST/AUTHORIZATION SUPPORTING DIRECTIVE MILPERSMAN ARTICLES 1810-010 AND 1810-040 PRIVACY ACT STATEMENT THE AUTHORITY TO REQUEST THIS INFORMATION IS CONTAINED IN 5 USC 301. THE PRINCIPLE PURPOSE OF THE INFORMATION IS TO ENABLE YOU TO MAKE KNOWN YOUR DESIRE FOR ITEMS LISTED OR FOR SOME OTHER SPECIAL CONSIDERATION OR AUTHORIZATION* THE INFORMATION WILL BE USED TO ASSIST OFFICIALS AND EMPLOYEES OF THE DEPARTMENT OF THE NAVY IN DETERMINING YOUR ELIGIBILITY FOR AND APPROVING OR DISAPPROVING THE SPECIAL CONSIDERATION OR AUTHORIZATION BEING REQUESTED. THE PRINCIPLE PURPOSE OF THE INFORMATION IS TO ENABLE YOU TO MAKE KNOWN YOUR DESIRE FOR ITEMS LISTED OR FOR SOME OTHER SPECIAL CONSIDERATION OR AUTHORIZATION* THE INFORMATION WILL BE USED TO ASSIST OFFICIALS AND EMPLOYEES OF THE DEPARTMENT OF THE NAVY IN DETERMINING YOUR ELIGIBILITY FOR AND APPROVING OR DISAPPROVING THE SPECIAL CONSIDERATION OR AUTHORIZATION BEING REQUESTED. COMPLETION OF THE FORM IS MANDATORY FAILURE TO PROVIDE REQUIRED INFORMATION MAY RESULT IN DELAY IN RESPONSE TO OR DISAPPROVAL OF YOUR REQUEST. COMPLETION OF THE FORM IS MANDATORY FAILURE TO PROVIDE REQUIRED INFORMATION MAY RESULT IN DELAY IN RESPONSE TO OR DISAPPROVAL OF YOUR REQUEST. 1. NAME 2. RATE 3. SHIP OR STATION 4. DATE OF REQUEST YYYYMMDD 5. DEPARTMENT/DIVISION 6. DUTY SECTION/GROUP 7. 1. NAME 2. RATE 3. SHIP OR STATION 4. DATE OF REQUEST YYYYMMDD 5. DEPARTMENT/DIVISION 6. DUTY SECTION/GROUP 7. NATURE OF REQUEST SPECIAL LIBERTY LEAVE 8. NO. OF DAYS REQUESTED FROM DATE AND TIME 9. DISTANCE MILES MODE OF TRAVEL COMMUTED RATIONS OTHER BELOW CAR AIR 10. .

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