Voluntary Furlough/Leave of Absence Request Form
Name:
Employee ID:
Department:
Supervisor:
Email Address:
Classified Staff
Faculty
Professional Staff
Below record dates, total hours and type of leave you are requesting.
Begin Date
End Date
Total Hours Requested
Leave Type
Voluntary Furlough
Leave of Absence
Voluntary Furlough
Leave of Absence
Voluntary Furlough
Leave of Absence
Voluntary Furlough
Leave of Absence
Approvals
________________________________
Employee Signature
________________________________
Supervisor Signature
________________________________
Dean or VP Signature
________________
Date
________________
Date
________________
Date
Approve
Decline
Approve
Decline
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signature
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signature
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signature
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