Fillable Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson)

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Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson)

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File type: PDF

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HUMAN RESOURCES DEPARTMENT
______________________________________________________
REQUEST FOR LEAVE
LEAVE REQUEST TO BE MADE FIVE WORKING DAYS IN ADVANCE EXCEPT IN AN EMERGENCY
____________________________________________ ____________________________________________
EMPLOYEE’S NAME DEPARTMENT
PAID TIME OFF: HOURS REQUESTED: ________
COMPENSATORY TIME: HOURS REQUESTED: ________
PERSONAL TIME: HOURS REQUESTED: ________
LEAVE OF ABSENCE: HOURS REQUESTED: ________
OTHER (Please Explain): HOURS REQUESTED: ________
________________________________________________
FIRST DAY OF LEAVE (DATE): _________________ LAST DAY OF LEAVE (DATE): _________________
Comments/Notes: ______________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
__________________________________________________________ ______________________________
EMPLOYEE’S SIGNATURE DATE SIGNED
LEAVE VERIFICATION
_________________________________ has _____________ hours of Paid Time Off,
Employee’s Name PTO
_____________ hours of Compensatory Time, and/or _____________ hours of
Comp Time Personal Time
Personal Time, per the Human Resources report from ______________________.
Pay Period Ending Date
APPROVAL / DISAPPROVAL
REVIEWED: ______________________________________________ DATE: __________
SUPERVISOR
APPROVED:
______________________________________________ DATE: __________
DEPARTMENT HEAD
DISAPPROVED:
___________________________________________ DATE: __________
DEPARTMENT HEAD
VERIFIED BY HUMAN RESOURCES:
__________________________ DATE: __________
MELANIE BAIRD-SIMMONS, HR MANAGER X5011
E-
MAIL mbaird-simmons@paysonaz.gov
K
ELLI SCHWEIN, HR ANALYST X5012
E-
MAIL kschwein@paysonaz.gov
K
ATHERINE JOST, PAYROLL SPECIALIST X5013
E-
MAIL kjost@paysonaz.gov
TOWN OF
303 N BEELINE HWY
P
AYSON, AZ 85541
(
928
)
474-5242 FAX
(
928
)
474-1151
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Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson)

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Completed 9 February 2021

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