Fillable Form 1: STAFF LEAVE REQUEST Month Year 11 (Starke County Indiana)

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Form 1: STAFF LEAVE REQUEST Month Year 11 (Starke County Indiana)

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The Form 1: STAFF LEAVE REQUEST Month Year 11 (Starke County Indiana) form is 1 page long and contains:

  • 2 signatures
  • 3 check-boxes
  • 70 other fields

Country of origin: US
File type: PDF

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STAFF LEAVE REQUEST
Employee _____________________________________________ Position
Month Year
Check for NO DAYS used
Comments:
This leave is to be charged to me for the above reason(s). Codes for days of absences are listed below.
S Sick Day
F Family Sick Day
P Personal Day
B Bereavement
T
Professional Leave (PD, Training)
Name
Relationship
O
J
V
Other leave approved by superintendent
Paid
Unpaid
Jury Duty
Vacation Day
(Letter of request on file)
C
Vacation Day
(Carry-over day from last year - Must be used within 3 months of Vacation Anniversary Date)
X Extra Day in the Calendar
Signature of Employee Signature of Supervisor
Please return to Payroll after completion.
Indicate
Indicate
Indicate
Indicate
Indicate
Indicate
FULL
S,F,P,B,
FULL
S,F,P,B,
FULL
S,F,P,B,
Day of
or
T,O,J,V
Day of
or
T,O,J,V
Day of
or
T,O,J,V
Absence
HALF
C,X
Absence
HALF
C,X
Absence
HALF
C,X
1
11 21
2
12 22
3
13 23
4
14 24
5
15 25
6
16 26
7
17 27
8
18 28
9
19 29
10
20 30
31
Relationship:
_______________________________
Covid-19 Related Absence
____________
E
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Form 1: STAFF LEAVE REQUEST Month Year 11 (Starke County Indiana)

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Completed 15 February 2022

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