Classified Staff & Managers
Requests for leave should be completed, signed and submitted to the Business Office one week in
advance for pre-planned activities.
Employee Name (Last Name, First Name):
EDUCATIONAL LEAVE: List specific days and hours in the Scheduled Dates section below.
Name of Conference, Meeting, Training or Activity: Sponsoring Organization:
Location (City and Facility): Purpose :
Hotel Stay Required:
Y
Y
e
e
s
s
N
N
o
o
Lodging Name/Location::
L
ist dates of stay: Funding Source:
SICK LEAVE: List specific days and hours in the Scheduled Dates section below.
Regular Sick Leave
Extended Sick Leave
Family Sick Leave <56 hours per academic year)
OTHER LEAVES: List specific days and hours in the Scheduled Dates section below.
Personal Necessity Leave (Classified employees refer to Local 1 Article 9.3.1 for approved usage definition.)
Vacation
Judicial/Official Appearance (subpoena)
Family Bereavement Leave
Authorized Leave without Pay
Industrial Leave
O
O
t
t
h
h
e
e
r
r
:
:
SCHEDULED DATES: List total hours for a week. By specific date, list from and to hours in that day.
Date or
Week
Time
Total Number
of Hours
Date or
Week
Time
Total Number
of Hours
SIGNATURES:
Approved
Manager/Supervisor Signature:
Approved
Not Approved
President/Designee Signature (as needed):
Actual leave is recorded from Online Absence Reports. Return distribution of this form will only be made for
conference/meeting leave, if disapproved or employee does not have sufficient leave to cover the request.
F
orm 7170 October 2010
