Fillable Date(s) Requested: From: through Hours _ LEAVE REQUEST (City of Stephenville)

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Date(s) Requested: From: through Hours _ LEAVE REQUEST (City of Stephenville)

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BROWSE CITY OF STEPHENVILLE (TX) FORMS

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LEAVE REQUEST FORM
Name: _
Date:
Department:
_ Title: _
VACATION LEAVE
Date(s) Requested: From: through Hours
_
S
ICK LEAVE
Date(s) Requested: From:
through Hours
_
O
THER LEAVE
Date(s) Requested: From
through Hours
_
Type of Leave: With Pay
Without Pay
Family and Medical Leave Act:
Yes
No
_________________________ ________________
Employee Signature
Date
SUPERVISOR ACTION
Approved
Denied
_________________________
Supervisor’s Signature
_________________________
Date
A
ppendix E
Form 11
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Date(s) Requested: From: through Hours _ LEAVE REQUEST (City of Stephenville)

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Completed 16 July 2020

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