Employee Request for Accrued Leave Usage
During Probation
Personal Information
First Name Last Name
Position Title Department
Supervisor's Name E-Number
Probation End Date Hire Date
Summary of Employee's Request
Dates of Leave
Total Hours Requested
Reason for Leave
______________________________
Employee Signature
______________________________
Supervisor Signature
Please print, sign, and return the completed form to the Benefits Office - Old Main Room 2031.
Human Resources Use Only:
Accrued Leave Balance ______ as of ___________.
Request Approved ______ Request Denied ______
Comments:
______________________________ ___________
Director of Human Resources Date
Date
cc:
Benefits
Payroll
Employee
Supervisor
