Fillable LeaveRequestFormRevisedAugust2017 - Leave Request Form Revised July 2017

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LeaveRequestFormRevisedAugust2017 - Leave Request Form Revised July 2017

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Coconino Community College
Non-Faculty Leave Request Form
To be completed by all employees requesting leave.
Submit the Leave Request Form to the appropriate supervisor for approval.
Employee Name: _______________________________________ Comet ID#: _________________________________
Dates of Absence: _______________________________________ Remarks: ___________________________________
Dates of Absence: _______________________________________Rem ark s: ___________________________________
Refer to Personnel Policies and Procedures regarding all leave noted below.
Please input leave time and DO NOT mark an "x" in the box by the leave.
Upon supervisor approval, drop off to Payroll or email to:
Payroll@coconino.edu and cc the employee requesting leave
Paid Time Off (PTO)
Sick Leave Reserve (SLR)
Sick Leave (SIK)
Comp. Time (non-exempt)
Bereavement Leave
Jury Duty
Military Leave
FMLA Sick FMLA PTO
Community Leave
Grand total :
Contact during absence (phone and/or email): ___________________________________________________________
Employee's Signature: ___________________________________________________ Date: _____________________
Supervisor's Signature: __________________________________________________ Date: ______________________
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LeaveRequestFormRevisedAugust2017 - Leave Request Form Revised July 2017

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Completed 16 November 2019

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