MEMORANDUM

TO: William Coleman, Town Manager

Valiria Willis, Human Resources Director

FROM: _________________________________

DATE: _________________________________

SUBJECT: Request for Leave Due to Military Call-Up

This memo will serve as notification that I have been called up for military duty on

________________________ and am requesting military leave for the duration of this duty.

date

I have been provided with a copy of the VETS Fact Sheet 3, "Job Rights for Veterans and Reserve Component Members", a copy of the Town Policy Statement 74 - Active Duty of Military Reservists, and the DOL FAQ Sheet "Reservists Called to Active Duty". I have reviewed this information and the Town policy and am aware of all of my rights and obligations under the law as well as Town policy.

______________________________________________ ___________________

Employee Signature Date

______________________________________________ ___________________

Approved by Town Manager Date

______________________________________________ ___________________

Acknowledged by Human Resources Director Date