Fillable Voluntary Unpaid Time-Off Request Employee Dates of Voluntary (DePaul University)

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Voluntary Unpaid Time-Off Request Employee Dates of Voluntary (DePaul University)

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Last updated 2.20.13
Voluntary Unpaid Time-Off Request
______________________________________________________________________________________
Employee
Last Name: First Name:
Employee ID Number:
Department:
Employment Type:
Salary/Exempt
Hourly/Non-Exempt
Campus Phone Extension:
Dates of Voluntary Unpaid Time-Off
Dates Requested (must be full day increments)
Date Range:
OR Specific Date(s) (please list):
Employee Acknowledgement/Agreement (Submit request at least 2 weeks prior to date(s) requested).
Please read carefully, sign and date to indicate that you have read and will comply with the terms of this agreement.
I understand that if this request is approved, it is based on my voluntary request and the time-off will be unpaid. I also
understand that I must not perform any work for/or on behalf of DePaul University during my voluntary unpaid time-off. If I
perform work on these dates, I will be paid for the dates or time worked. In order to continue benefits coverage during
voluntary unpaid time-off, I may be required to make arrangements with the HR Benefits Department for payment of required
benefit premiums. I understand that I will also continue to accrue applicable sick and/or vacation time during my voluntary
unpaid time-off.
Employee Signature:
Date:
Supervisor Approval
This voluntary unpaid time-off requires supervisor approval. Your supervisor will complete and submit the completed form to
the HR Benefits Department.
The requested voluntary unpaid time-off is: Approved Denied
Comments:
Supervisor Name:
Supervisor Title (Print): Date:
Human Resources:
The Request for the Voluntary Unpaid Time-off is:
Approved Denied
If denied, reason for denial:
HR Representative Name: Title:
HR Representative Signature: Date Received:
Date Approved:
All voluntary unpaid time-off request forms are placed in the employee benefits file.
Phone 312/362-8232
Fax 312/476-3227
hrbenefits@depaul.edu
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Voluntary Unpaid Time-Off Request Employee Dates of Voluntary (DePaul University)

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Completed 25 February 2022

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