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Full Name (Name Listed on Passport): Date:
Type of Leave (Ordinary, Emergency, Extension, EOC, Other):
NUMBER DAYS LEAVE
Accrued: Requested: Advanced: Excess: From:
Departing City / Airport: Arrival City / Airport: Emergency Contact While Traveling: Telephone Number During Travel:
Passport number: Country issued: ISAF badge number: Purpose of Leave:
Passenger Date of Birth:
Last four CAC number:
Remarks/Comments: Does the person requesting leave want CSMI to make travel arrangements? ______ YES ______ NO
***Should an emergency travel related event occur, please contact Travizon Travel at
5. Lack of coordination will result in non-reimbursement for leave travel. 4. No leave(s) will be authorized for longer than 30 days. End of Contract Leave will be coordinated by Doug Fellows with AS&E. Chris Knox Point of Contact: Office: (978) 989-9460. Cell: 314-566-1757. Authorization: Contractor must submit this form for approval by the Program Manager before taking any type of leave.*** INSTRUCTIONS TO CONTRACTOR: 1.Com 6. Submission: Program Managers must submit the Request and Authorization for Leave directly to CSMI Program Manager Art Heredia with their approval / disapproval. Changes: Contractors who desire changes to authorized leave must notify the Program Manager of these changes. You are required to also send a follow-up e-mail to both Program Managers David Leary and Chris Knox. Leave requests submitted by the contractor directly to CSMI will not be accepted. 3. CSMI will not pay for any leave dates if a Request and Authorization for Leave for was not submitted and authorized by the Program Manager. 2. Contractors desiring to make their own flight arrangements must coordinate with Chris Knox prior to making those arrangements. Leave Extensions: Must be coordinated and approved by CSMI prior to the end of leave. . Flights: All leave flights must be coordinated through Chris Knox.their 24-hour telephone number of (425) 947-1210. E-mail: CKnox@CSMI.