INDIAN HILLS COMMUNITY COLLEGE
Non-Scheduled Day (s) / Bank Days / Leaves / Vacation
THIS FORM MUST BE APPROVED BY THE HUMAN RESOURCES DEPARTMENT IN ADVANCE
NAME: EMPLOYEE #
CHECK APPROPRIATE BOX (S)
Note: An employee must actually work a non-scheduled day/school closed day to generate a bank day. Bank days may not be taken off before they are earned.
Must be worked in whole or half days, but can be used in hour increments.
NON-SCHEDULED DAYS
Working Non-Scheduled Day Date (s): (If half day mark AM or PM)
Explanation Required (below)
Using a Bank Day Date (s):
Note: Faculty must include information on how classes will be covered.
Cancel
Working a Non-Scheduled Day Date (s):
Using a Bank Day Date (s):
Other (explain):
LEAVES
Personal Leave Note: Bank days and/or vacation time must be taken before personal leave is approved.
With Pay
Without Pay Date (s):
Explanation Required (below)
Sick Leave
Personal
Immediate Family
FMLA (more than three consecutive days) Date (s):
Explanation Required (below)
Other (explain):
VACATION DAYS Date (s):
(For Maintenance or Custodial employees)
EXPLANATION: Note: Faculty must include information on how classes will be covered.
Employee Signature: Date:
Dept./Supv. Approval: Date:
Human Resources Approval: Date:
ORIGINAL - Human Resources YELLOW - Employee
8/18PER21
