Chaffey College
Human Resources
REQUEST FOR PAID LEAVE
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It is the employee’s responsibility to confirm available leave balance prior to submission of this form to the supervisor.
Name:
Date:
Department:
Employee ID:
I request (please check appropriate box). Note: personal business, compensatory leave and floating holiday apply
to CSEA and Confidential only.
(Pre-approval not required for PN)
Personal necessity
Hours
Vacation
Hours
Personal business
Hours
Compensatory leave
Hours
for the following days:
Floating holiday
1 Day
Beginning
Ending
Return to Work
Total Hours
Day/Date:
Employee Signature
Date
Supervising Manager’s Determination:
Note: Supervisors with employees under the CSEA Agreement shall respond to the request for paid leave within five
working days of the written request.
Date request received:
To:
(Employee)
From:
(Supervising Manager)
Re:
Request for Leave
The leave requested above is approved.
The leave requested above is not approved.
Comments:
Supervisor Signature
Date
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0