Fillable Leave Request Form -2018

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Leave Request Form -2018

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BROWSE CITY (AR) FORMS

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09
/2018
CITY OF LITTLE ROCK
LEAVE REQUEST
FORM
Employee: ___________________________________
Employee Number: _______________
DATES OF LEAVE(S): ___________________________________
TYPE OF LEAVE: BEGIN/END of LEAVE TIME:
Paid Time Off (PTO) TO
Short Term Disability (STD) TO
(Must also include STD form signed by Department Director)
FMLA TO
(Must also check either PTO, STD or COMP time)
Leave Without Pay TO
Administrative Leave TO
Comp Time TO
TOTAL TIME REQUESTED Hours Minutes
Supervisor’s Approval:
___________________________________________
Comments:
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Leave Request Form -2018

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Completed 21 March 2020

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