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SOUTHERN UNIVERSITY SYSTEM (Southern University at Shreveport)

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UNVERIFIED BALANCES MAY RESULT IN DEDUCTIONS OF FUTURE SALARY PAYMENTS WHEN LEAVE IS NOT AVAILABLE. LEAVE TYPES IN THIS DOCUMENT ARE GENERAL AND
APPLY TO MOST SITUATIONS. FOR OTHER TYPES (FMLA, SABATICAL, WORKER’S COMPENSATION, ETC) OTHER FORMS MAY APPLY. THIS DOCUMENT DOES NOT REPLACE OR
CHANGE SOUTHERN UNIVERISTY SYSTEM RULES, POLICES, NOR FEDERAL, STATE LAW. PLEASE CONTACT YOUR HUMAN RESOURCES DEPARTMENT FOR MORE
INFORMATION
APPLICATION FOR LEAVE
SUBR SUS
SUNO SUSLA
LAST NAME
FIRST
NAME
M.I.
TODAY'S DATE
BANNER ID DEPT
FUNERAL CIVIL MILITARY LWOP OTHER
DURATION OF LEAVE (IF APPLICABLE, hours- 2pm-5pm):
DATES OF LEAVE (DATES 4/1-3/15):
TYPE OF LEAVE REQUESTED (select as applicable):
REASON FOR ABSENCE:
I certify that my absence was for the reasons noted above. Falsification of this request or supporting documentation is grounds for disciplinary actions up to and including termination
of employment. I understand that the status of this request is subject to (although not exclusively) to available leave balances .
EMPLOYEE’S SIGNATURE:
ADMINISTRATIVE APPROVALS: SUPERVISORS MUST VERIFY THAT LEAVE TYPE AND DURATION IS ADEQUATE. EMPLOYEES REQUESTING LEAVE SHOULD BE GIVEN A COPY OF THIS
FORM ONCE APPROVED OR NOT APPROVED
APPROVED DISAPROVED BY SUPERVISOR/DEPARTMENT HEAD
APPROVED DISSAPROVED BY HUMAN RESOURCES DEPARTMENT
APPROVED DISSAPROVED BY PRESIDENT AND/OR CHANCELLOR
SOUTHERN UNIVERSITY SYSTEM
SULC
SUAREC
AMOUNT OF LEAVE REQUESTED (IN HOURS, i.e. 24):
ANNUAL
SICK
COMP
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SOUTHERN UNIVERSITY SYSTEM (Southern University at Shreveport)

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Completed 26 July 2020

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