PERSONAL LEAVE REQUEST FORM
Employee
Name:
Date:
Job Title:
Department:
Leave Begin & End Dates:
Reason for Leave:
I have read and understand the Wilkes University Unpaid Personal Leave policy and agree to abide by
its terms.
_______________________________________
Employee Signature
_______________________
Date
Probationary Period Completed?
_________________________________
Date
_________________________________
Date
__________________________________
Date
---------- SUPERVISOR AND HUMAN RESOURCES PURPOSES ONLY BELOW THIS LINE ----------
Yes
____________________________________
Supervisor Signature
____________________________________
Next Level Supervisor Signature
____________________________________
Human Resources Signature
No
Personal Leave Approved?
Yes
No
Once the form is complete please print, sign and return to your direct supervisor for review.
WIN:
