Employee Leave Request Form printable pdf download

Employee Leave Request Form

EMPLOYEE LEAVE REQUEST FORM

NAME:

___________________________________________________________________________________________

DATE(S) OF

LEAVE: ________________________________________________________________________________

REASON FOR LEAVE*: ______________________________________________________________________________

* NOTE: ANY EMPLOYEE WHO FALSELY CERTIFIES IN THIS RESPECT SHALL BE LIABLE FOR DISCIPLINARY ACTION INCLUDING DISMISSAL.

HOURS

______ VACATION HOURS REQUESTED

______ COMP TIME REQUESTED

______ PERSONAL LEAVE REQUESTED

______ FLEX TIME REQUESTED

______ SICK LEAVE REQUESTED

______ JURY DUTY

______ PROFESSIONAL DEVELOPMENT**

______

OTHER DUTIES (FIELD TRIPS, ETC.)**

DESCRIPTION NEEDED BELOW

______ PLANNING DAYS (TEACHERS ONLY)

______

BEREAVEMENT LEAVE HOURS REQUESTED

______ ATHLETICS / ACTIVITIES

______ PERSONAL LEAVE DEDUCT SUBSTITUTE

(TEACHERS ONLY)

EMPLOYEE SIGNATURE:

______________________________________________________________________________

APPROVED

BY:

________________________________________________________________________________

**ADDITIONAL HELPFUL INFORMATION / DESCRIPTION:_____________________________________________________

____________________________________________________________________________________________________

D‐22 REV 8‐5‐16

Original: Office

Copy For Staff Members

Employee Leave Request Form