Employee Name
Vacation Leave Requested:
Total
from through Hours
Leave for Personal Purposes--Faculty Only:
Total
from through Hours
Leave without pay:
Total
from through Hours
Other:
Military/Jury
Sick
Total
from through Hours
Employee's Signature & Date
Authorized Approval & Date
Signature Date Signature Date
Original to Payroll Duplicate to Employee
Montana State University-Northern
LEAVE REQUEST
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