Fillable Request and Authorization for Leave (New Mexico Institute of Mining & Technology)

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Request and Authorization for Leave (New Mexico Institute of Mining & Technology)

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The Request and Authorization for Leave (New Mexico Institute of Mining & Technology) form is 1 page long and contains:

  • 3 signatures
  • 21 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

U.S.A. forms for New Mexico Institute of Mining & Technology

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Request and Authorization for Leave
Send Completed Form to Human Resources
Please refer to the Employee Handbook for complete descriptions of the various types of leave available.
General Information
Leave Form
HOURLY
SALARIED
EMPLOYEE ID NUMBER
Type or Print Employee Name Date
Department
I request leave beginning at
on
, ending at
Time
Supervisor
on
Date
Date
a total of
Check
√
one of the following reasons:
Employee Signature
Date
Approved:
Supervisor Signature
Date
I request Family or Medical Leave (FMLA) for the following reason:
Check
√
one of the following reasons:
A serious health condition that makes you unable to perform the essential functions of your job.
A serious health condition affecting your
provide care.
Spouse,
Child,
Parent for which you are needed to
The birth of your child, or the placement of a child with you for adoption or foster care. This leave needs to
start on and is expected to end on .
Date
Date
Medical certification
supporting the need for an employee to care for their own, or their spouse’s, child’s or parent’s
serious
illness is required. Medical certification forms are available in the Human Resources Office.
Medical Certificate is attached.
The
requesting employee will be notified of the status of the request within two working days of the request being
Received in the Human Resources Office.
Employee Signature
Date
Family or Medical Leave
Annual Leave – Annual leave needs to be requested at least 3 working days in advance
Sick Leave - Sick leave is used when conditions do not permit the use of Family or Medical Leave
Personal Day - One day per calendar year
Emergency Leave - Up to three consecutive days per year for family members specified in Handbook
Military Leave - Up to three weeks per year
Funeral Leave - Up to three consecutive days for family members specified in Handbook
Jury Duty - Summoned to appear for jury duty
Court Leave - Subpoenaed to appear in court as a witness
Compensatory Time
Leave without Pay - for use when sick and annual leave is unavailable
Emergency Leave Paid Sick Leave
Emergency Family and Medical Leave Expansion
Time
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Request and Authorization for Leave (New Mexico Institute of Mining & Technology)

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Completed 1 February 2021

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