Fillable TYPE OF LEAVE REQUESTED (Montana Tech)

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TYPE OF LEAVE REQUESTED (Montana Tech)

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NAME: (Last, First, Middle)
TITLE: DEPARTMENT:
Military Leave (Include military orders with request)
Leave Without Pay* (LWOP)
* Any Leave Without Pay may affect medical premiums and/or eligibility for health insurance. Health insurance
may lapse unless it is paid in advance. Please make arragenments with the Human Resources Office.
JUSTIFICATION (To be completed by employee - please provide reasons for request):
Signature of Applicant
Date
Signature of Supervisor
Date
Signature of HR Director
Date
Dean (Highlands)
Date
Dept. Head
Date
Chancellor Date
Dean Date
Provost
Date
Vice Chancellor A&F
Date
Vice Chancellor A&F
Date
Chancellor
Date
APPROVAL FOR NORTH CAMPUS FACULTY
End Date:
Juror or Witness Leave (Include documentation with request)
FOR HUMAN RESOURCES USE ONLY
LEAVE WITHOUT PAY
APPROVAL FOR PROFESSIONALS AND ADMINISTRATORS
Start Date:
DATES OF REQUESTED LEAVE
SUPERVISOR:
APPROVAL FOR HIGHLANDS COLLEGE FACULTY
LEAVE WITHOUT PAY
LEAVE WITHOUT PAY
EMPLOYEE ID NUMBER:
APPLICATION FOR LEAVE
TYPE OF LEAVE REQUESTED
JURY/WITNESS DUTY OR MILITARY LEAVE FOR ALL EMPLOYEES and LEAVE WITHOUT PAY FOR CLASSIFIED EMPLOYEES:
APPROVAL SECTION - Forward to HR Director after supervisor has approved below.
Approved
Disapproved
Approved
Disapproved
Approved
Disapproved
DisapprovedApproved
Approved
Disapproved
Disapproved
Approved
Approved
Approved
Approved
Approved
Disapproved
Disapproved
Disapproved
Disapproved
LEAVE REQUEST 2018
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TYPE OF LEAVE REQUESTED (Montana Tech)

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Completed 23 August 2020

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