Louisiana State University
APPLICATION FOR LEAVE
SECTION: _______________________________________________
NAME: __________________________________________________ Requests _____ Hours of Leave
TYPE OF LEAVE:
ANNUAL SICK LEAVE WITHOUT PAY COMPENSATORY Other
REMARKS: ___________________________________________________________________________________
BEGIN DATE: _____________________________ BEGIN TIME: ______________________________
END DATE: _____________________________ END TIME: ______________________________
* I certify that my absence from duty was for the reason noted.
EMPLOYEE SIGNATURE: _________________________________________ DATE: ______________________
SUPERVISOR SIGNATURE: _______________________________________ DATE: ______________________
Louisiana State University
APPLICATION FOR LEAVE
SECTION: _______________________________________________
NAME: __________________________________________________ Requests _____ Hours of Leave
TYPE OF LEAVE:
ANNUAL SICK LEAVE WITHOUT PAY COMPENSATORY Other
REMARKS: ___________________________________________________________________________________
BEGIN DATE: _____________________________ BEGIN TIME: ______________________________
END DATE: _____________________________ END TIME: ______________________________
* I certify that my absence from duty was for the reason noted.
EMPLOYEE SIGNATURE: _________________________________________ DATE: ______________________
SUPERVISOR SIGNATURE: _______________________________________ DATE: ______________________
Louisiana State University
APPLICATION FOR LEAVE
SECTION: _______________________________________________
NAME: __________________________________________________ Requests _____ Hours of Leave
TYPE OF LEAVE:
ANNUAL SICK LEAVE WITHOUT PAY COMPENSATORY Other
REMARKS: ___________________________________________________________________________________
BEGIN DATE: _____________________________ BEGIN TIME: ______________________________
END DATE: _____________________________ END TIME: ______________________________
* I certify that my absence from duty was for the reason noted.
EMPLOYEE SIGNATURE: _________________________________________ DATE: ______________________
SUPERVISOR SIGNATURE: _______________________________________ DATE: ______________________
CAMD