JOINT TASK FORCE RATTLESNAKE AUTHORIZED ABSENCE REQUEST

JOINT TASK FORCE RATTLESNAKE AUTHORIZED ABSENCE REQUEST
Email*
example@example.com
Date*

MonthDayYear
Date
Full Name*
Rank*
Pay Grade*
Crew Location*
Unit / Squadron*
FROM (YYYYMMDD)*

YearMonthDay
Date
TO (YYYYMMDD)*

YearMonthDay
Date
Total Days Requested*
Travel Details
Address*

Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Emergency Contact Name*
Emergency Contact Number*
Foreign Travel Briefing/Training Admin Requirements (If Applicable)
Antiterrorism Level 1 Training (http://jko.jten.mil/courses/atl1/launch.html)

YearMonthDay
Date
Smart Traveler Enrollment Program (STEP) (https://step.state.gov/step/)

YearMonthDay
Date
Country Specific Information, Warnings, Alerts & Cautions
TYPE OF ABSENCE
OrdinaryOut Of StateEmergencyParental Primary CareProfessional Military EducationParental Secondary CareMaternity ConvalescentOut Of CountryOther
Non-chargeable*

ChargeableNon-chargable
Sick Absence Request
For absences over three days, the service member shall provide a statement from a medical doctor, licensed in the State of California, verifying the limitation(s) that affect the service member's ability to perform duty or render the service member unable to perform duty. The doctor visit shall occur NLT the fourth day.
Number of days MIA

1 Sick Day Used2 Sick Days Used3 Sick Days Used
Return To Duty Date

YearMonthDay
Date
Date Seen by Medical Provided:

YearMonthDay
Date
Remarks
Please state how many days of leave and the type of leave you're using. (EX. 2 days of ordinary leave)*
Please state the dates You're abandoning JTFRS (EX. From Mar 31st until the 3rd)*
Please state your reason for taking leave*
NOTICE

I certify that the duty and leave status recorded above are correct and that all duty and leave was documented in accordance with California Military Department policy and regulations. I further certify that there has been no change in my military affiliation or marital/dependent status during this period.
I have reviewed the duty and leave annotated above and I certify that it is correct and in accordance with California Military Department policy and regulations.
Service Member Signature*

Clear
JTFRS Form 004 11JAN24 (All Previous Versions Are Obsolete)
Should be Empty:

JOINT TASK FORCE RATTLESNAKE AUTHORIZED ABSENCE REQUEST

Travel Details

Foreign Travel Briefing/Training Admin Requirements (If Applicable)

TYPE OF ABSENCE

Sick Absence Request

Remarks

NOTICE