Leave Request Form - Atlantic Beach

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Town of Atlantic Beach
LEAVE REQUEST FORM
This form must be utilized for the taking of all leave (vacation, sick, compensatory, court,
military, etc…), and must be completed and approved prior to the taking of leave, except
in the case of sudden illness. There are no exceptions.
DATE SUBMITTED:
NAME:
POSITION:
DEPARTMENT:
TYPE OF LEAVE REQUESTED:
(vacation, sick, compensatory, leave without pay)
PERIOD FOR WHICH LEAVE IS REQUESTED:
(State # of hours and for which dates - if leave
is to be taken during work day, state actual time you will be leaving and/or returning)
By signing below, I certify that the amount of time and type of leave I am asking for has been
accrued and is in accordance with the Town’s Personnel Resolution. If all leave has been exhausted,
I understand this leave must be taken as leave without pay.
EMPLOYEE’S SIGNATURE: _____________________________________________
APPROVED / DISAPPROVED
(circle one)
TOWN MANAGER OR DEPT HEAD: _____________________________________
Signature
DATE:
REASON FOR DISAPPROVAL:
(if applicable)
IF APPROVED, THE ORIGINAL GOES BACK TO THE EMPLOYEE AND A COPY STAYS WITH
THE TOWN MANAGER/DEPARTMENT HEAD.
THE EMPLOYEE IS TO ATTACH THE
APPROVED ORIGINAL TO THEIR WEEKLY TIMESHEET. IF NOT APPROVED, THEN THE
ORIGINAL FORM IS RETURNED TO THE EMPLOYEE WITH AN EXPLANATION.

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