APPLICATION FOR LEAVE
SF-6 (R 12-04)
AGENCY
Employee Name
I request ___________
hours of leave.
From: __________ AM PM
/ /
To: __________ AM PM
/ /
Chargeable Leave Request FMLA: Self LWOP
Annual Straight Compensatory Family
Sick Time and One-Half Compensatory Unpaid
Non-Chargeable Leave Request EDUCATIONAL: SPECIAL:
Funeral Job Related Act of God
Office Closure
Jury Duty
MILITARY: (max. 15 days per year) Civil Air Patrol American Red Cross
Hazard Duty (law enf)
Active Emergency Civilian Voting
Other ____________________
Training
(Explain in “Comments” Section) Physical
Comments
I CERTIFY THAT MY ABSENCE FROM DUTY WAS FOR THE REASON NOTED
Employee Signature
Date
Approved by and Title
Leave Definitions
Absence Leave Request:
Annual: leave with pay granted an employee for the
purpose of rehabilitation, restoration and maintenance
of work efficiency, or transaction of personal affairs.
Sick:
leave with pay granted an employee who is
suffering with a disability which prevents him from
performing his usual duties and responsibilities or who
requires medical, dental or optical consultation or
treatment.
Straight Compensatory: overtime leave earned by
employees exempt from federal Wage and Hour laws
when they have physically worked hours in excess of
their regular schedule.
Time and One-Half Compensatory:
overtime leave
earned by employees who are non-exempt under
federal Wage and Hour laws when they have physically
worked hours in excess of their regular schedule.
LWOP:
Leave Without Pay
FMLA: (Family and Medical Leave Act) approved
absence available to eligible employees for up to 12
weeks of leave per year for certain family and medical
reasons.
Self:
for employee’s own serious health condition.
Family:
an immediate family member (spouse, child or
parent) with a serious health condition.
Unpaid:
when paid leave (annual/sick) is exhausted or
cannot be used under specific circumstances.
Non Chargeable Leave Request:
Funeral: leave granted when attending the funeral or burial
rites of a parent, step-parent, child, step-child, brother, step-
brother, sister, step-sister, spouse, mother-in-law, father-in-
law, grand-parent or grand-child, provided such time off
shall not exceed two days on any one occasion.
Jury Duty:
summoned to perform jury duty.
Hazard Duty (law enf):
granted when an employee
engaged in law enforcement work is disabled while in the
performance of duty of a hazardous nature and because of
such disability is unable to perform his usual duties. (Civil
Service Rule 11:21.1)
OTHER
Any other special or non-chargeable leave request as
provided in Chapter 11 of the C.S. Rules.
EDUCATIONAL
Job Related: leave granted to attend a course that is
relevant to job.
MILITARY
(maximum 15 days per year)
Active:
leave granted when called to active military duty.
Training:
annual training or active duty for training
(weekend drills).
Physical:
leave granted to conduct mandatory physical to
enlist in military.
SPECIAL
Act of God:
appointing authority determines the employee
is prevented by an act of God from performing duty.
Civil Air Patrol: a member of Civil Air Patrol ordered to
perform duty with troops or participate in field exercises or
training. Leave shall not exceed 15 working days in any
one calendar year.
Emergency Civilian:
performing emergency civilian duty in
relation to national defense.
Office Closure:
leave granted due to local conditions which
prevent the employee from attending work.
American Red Cross:
leave granted for a period not to
exceed 15 work days in any calendar year to participate in
American Red Cross relief services in Louisiana for
disasters designated as Level III or above in the American
Red Cross Regulations and Procedures. Must be certified
as a Trained Disaster Volunteer and approved by
appointing authority.
Voting:
leave granted when voting in a primary, general or
special election which falls on regular scheduled work days,
provided not more than two hours of leave shall be allowed
to vote in the parish where he is employed and not more
than one day to vote in another parish.
River Parishes Community College
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