Please check:
Vacation Leave 2017 - 2018 Non-Expiring Leave Funeral Leave Workers Comp
Sick Leave 2018 - 2019 Special Annual Leave Civil Leave Voluntary Shared
Leave
2014 - 2015 Bonus Leave Personal Leave Military Leave
Is this FMLA Leave? Yes No Check if this is an UNPAID leave of absence
(Supervisor to complete)
EMPLOYEE NAME ____________________________________________________________________________________________________
DATE(S) OF LEAVE _______________________________________________________________ TOTAL HOURS __________________
TIME(S) OF LEAVE (if partial day): _____________________________________________________________________________________
REQUESTED BY: _____________________________________________________________________________________________________
*
APPROVED BY: ______________________________________________________________________________________________________
*
COMMENTS: __________________________________________________________________________________________________________
*By typing/signing your name as the requester/approver, you agree to the accuracy of the leave reported on this form.
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