MILITARY LEAVE WORK SHEET
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This work sheet is to be completed by both the employee and his/her Personnel Office prior to reporting for military service. Items 1
through 8 are to be completed by the employee. Items 9 and 10 are to be completed by both the employee and the Personnel Office.
Items 11 through 14 are to be completed by the Personnel Office only when the employee is eligible to receive the difference between
his/her military pay, and his/her State pay. Item 14 is to be completed if the employee resides in another state. Contact the State
Controller's Office (SCO) for instructions for completing item 14. A Savings Plus Qualified Military Service Loan Repayment Agreement
must be completed if the employee has an outstanding Savings Plus loan. The employee should be apprised of and complete any
additional documentation as a result of necessary discretionary deduction changes. A copy of the employee’s military orders (or official
military correspondence) MUST be attached.
1. NAME (Last, First, Initial)
2. SOCIAL SECURITY NUMBER
3. CIVIL SERVICE CLASS TITLE
4. MILITARY RANK
5. DATE MILITARY LEAVE BEGINS
DATE MILITARY LEAVE ENDS
6. IF YOU HAVE DIRECT DEPOSIT, DO YOU WISH TO CONTINUE?
NO (If NO, submit STD Form 699 to cancel)
7. I ELECT PAYMENT OF LEAVE CREDITS (other than sick leave)
YES (If YES, please explain.)
8. FORWARD MY WARRANT TO:
9. MAINTAIN THE FOLLOWING STATE PAYROLL DEDUCTIONS:
These deductions will be maintained automatically when you are eligible to receive the difference between military pay and State pay, even if your
military pay is more than your State pay. If ineligible for “difference” p