Application For Leave Of Absence Form

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UNIVERSITY OF HAWAI‘I - APPLICATION FOR LEAVE OF ABSENCE
DOC. NO.
01. UH Username OR Number
02. NAME (LAST,FIRST, MI)
START WITH FIRST THREE LETTERS OF LAST NAME
01 Vacation
05 Bereavement (See Note 2)
09 LWOP-Prof Imp Leave
03. LEAVE CODE
04. TYPE OF LEAVE
06 Military
10 LWOP-Other (See Note 3)
02 Sick (See Note 1)
03 Sick-Industrial Injury
07 LWOP-Maternity
11 Compensatory Time Off
08 LWOP-Health
12 Jury/Witness Duty
04 Sabbatical/Prof Imp
Leave with Pay
06. USE FOR CORRECTION ONLY
05. INCLUSIVE DATES OF LEAVE
THIS REPLACES DOC. NO. ________________________________
FROM _____/_____/____ THRU _____/____/____
REMARKS:
MONTH DAY
YEAR
MONTH DAY YEAR
07. WORKING HOURS TAKEN
08. EMPLOYEE’S SIGNATURE
09. DATE
_____/_____/____
MON DAY YEAR
10. DEPARTMENT
11. SUPERVISOR’S SIGNATURE
12. DATE
UNIVERSITY OF HAWAI‘I - APPLICATION FOR LEAVE OF ABSENCE
DOC. NO.
COPY
COPY
01. UH Username OR Number
02. NAME (LAST,FIRST, MI)
COPY
COPY
START WITH FIRST THREE LETTERS OF LAST NAME
01 Vacation
05 Bereavement (See Note 2)
09 LWOP-Prof Imp Leave
03. LEAVE CODE
04. TYPE OF LEAVE
06 Military
10 LWOP-Other (See Note 3)
COPY
02 Sick (See Note 1)
COPY
03 Sick-Industrial Injury
07 LWOP-Maternity
11 Compensatory Time Off
08 LWOP-Health
12 Jury/Witness Duty
04 Sabbatical/Prof Imp
Leave with Pay
COPY
COPY
06. USE FOR CORRECTION ONLY
05. INCLUSIVE DATES OF LEAVE
THIS REPLACES DOC. NO. ________________________________
FROM _____/_____/____ THRU _____/____/____
COPY
COPY
REMARKS:
MONTH DAY
YEAR
MONTH DAY YEAR
07. WORKING HOURS TAKEN
08. EMPLOYEE’S SIGNATURE
09. DATE
COPY
COPY
_____/_____/____
MON DAY YEAR
COPY
COPY
10. DEPARTMENT
11. SUPERVISOR’S SIGNATURE
12. DATE
COPY
COPY
UNIVERSITY OF HAWAI‘I - APPLICATION FOR LEAVE OF ABSENCE
DOC. NO.
COPY
COPY
01. UH Username OR Number
02. NAME (LAST,FIRST, MI)
COPY
COPY
START WITH FIRST THREE LETTERS OF LAST NAME
01 Vacation
05 Bereavement (See Note 2)
09 LWOP-Prof Imp Leave
COPY
COPY
03. LEAVE CODE
04. TYPE OF LEAVE
06 Military
10 LWOP-Other (See Note 3)
02 Sick (See Note 1)
03 Sick-Industrial Injury
07 LWOP-Maternity
11 Compensatory Time Off
08 LWOP-Health
12 Jury/Witness Duty
04 Sabbatical/Prof Imp
Leave with Pay
COPY
COPY
06. USE FOR CORRECTION ONLY
05. INCLUSIVE DATES OF LEAVE
THIS REPLACES DOC. NO. ________________________________
COPY
COPY
FROM _____/_____/____ THRU _____/____/____
REMARKS:
MONTH DAY
YEAR
MONTH DAY YEAR
COPY
COPY
07. WORKING HOURS TAKEN
08. EMPLOYEE’S SIGNATURE
09. DATE
_____/_____/____
MON DAY YEAR
COPY
COPY
10. DEPARTMENT
11. SUPERVISOR’S SIGNATURE
12. DATE
COPY
COPY

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