Leave Request Form - North Colonie
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Print Form
North Colonie Central School Dletrlct
Leave Request For1n
MANAGEMENT CONFIDENTIAL
Full Name:
Employee
(Print)
Signature:
Dept/Bldg:
Today's Date:
I
I
Complete this form and submit it to your immediate supervisor for approval. Separate requests for leave time requires
separate forms. All requests for Vacation and Personal leave should be approved in advance prior to the requested date(s).
It is your responsibility to ensure that you have the leave time available prior to the request being submitted. Please
consult the Mgmt Confidential MOU for more information and contact the Payroll Department for leave balances.
Personal:
Must be approved in advance by your supervisor and the Assistant Superintendent for Business unless there is an
acceptable emergency situation.
D
Personal-Non Chargeable*
D
Personal-charge to Sick**
Date
#of Hours
Reason
(if applicable)
I
I
*A valid reason must be provided if request is submitted without four (4) work days notice.
(Time
Card
Code
E)
**IfPersonal Leave is exhausted, employees with three or more years of completed service can request up to three additional
Personal days (Personal-Charge to Sick). Must give a reason & at least five (5) work days notice.
(Time Card Code F)
Vacation:
All time must be approved, in advance, by your immediate supervisor. (Time Card Code B)
Number of Days
Date(s)
Other:
(specify)
Supervisor approval only
Date: _ _/ _ _/ _ _
(Ex: Floating Holiday, Leave wfo pay, military leave-attach appropriate documentation, if required)
Approvals/ Denials:
Immediate Supervisor
Date
D
APPROVED
D
DENIED
___}__}_ D
APPROVED
D
DENIED
Asst. Superintendent for Business
Date
Comments:
0
Original to Payroll
0
Employee Copy
0
Supervisor Copy
Rev 11/14/11
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Parent category: Business