Form 49044 - State Employee Community Service Program Request For Leave And Verification Of Services Provided - State Of Indiana

Download a blank fillable Form 49044 - State Employee Community Service Program Request For Leave And Verification Of Services Provided - State Of Indiana in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 49044 - State Employee Community Service Program Request For Leave And Verification Of Services Provided - State Of Indiana with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

STATE EMPLOYEE COMMUNITY SERVICE PROGRAM
REQUEST FOR LEAVE AND VERIFICATION OF SERVICES PROVIDED
State Form 49044 (R / 4-99)
PART 1 - REQUEST FOR LEAVE
To be filled out by employee:
I, ______________________________________________________________ , request leave in accordance with Executive Order 98-13 to participate in
(Name of employee)
__________________________________________________________________________________________________________________________
(Name of program)
on ___________________________________ from ____________________ to ____________________ .
(Date)
(Time)
(Time)
Printed name of employee
Signature of employee
Date (month, day, year)
PART 2 - VERIFICATION OF PRIOR VOLUNTARY SERVICE
To be filled out by authorized representative of a governmental entity or tax exempt organization:
I am an authorized representative of ____________________________________________________________________________________________
(Name of organization)
which is a governmental entity or is exempt from federal income tax. I verify that the above named individual performed _________________ hours of
voluntary service on behalf of the organization on __________________________ .
[Date(s)]
Signature of Authorized Representative
Printed name of Authorized Representative
Title
Telephone number
PART 3 - EMPLOYING AGENCY'S RESPONSE TO LEAVE REQUEST
To be filled out by agency head's designee:
The above request for leave is:
Approved
Disapproved
If disapproved, reason:
Date (month, day, year)
Signature of Agency Head's Designee
PART 4 - VERIFICATION OF VOLUNTARY SERVICES PERFORMED DURING NORMAL HOURS OF EMPLOYMENT
To be filled out by an authorized representative of a governmental entity or an organization that is exempt from federal income tax under
Section 501(c) (3) of the Internal Revenue Code:
I verify that voluntary services were performed by the above name state employee on behalf of ___________________________________________
(Name of organization)
on _______________________________ from ____________________ to ____________________. I confirm that the volunteer activities did not promote
(Time)
(Time)
(Date)
religion or attempt to influence legislation, governmental policy, or election to public office.
Signature of Authorized Representative
Printed name of Authorized Representative
Title
Telephone number

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Wku Request For Leave And Notice Of Eligibility And Rights & Responsibilities (family And Medical Leave Act) Wku Request For Leave And Notice Of Eligibility And Rights & Responsibilities (family And Medical Leave Act) Business
Request For Leave And Approved Absence Request For Leave And Approved Absence Business
Form 851 - Request For Research Or Verification Of Motor Vehicle Record Form 851 - Request For Research Or Verification Of Motor Vehicle Record Legal
Form Rs 6047-n - World Trade Center Notice For Members And Retirees Of The New York State And Local Retirement System Form Rs 6047-n - World Trade Center Notice For Members And Retirees Of The New York State And Local Retirement System Legal
Form Mvt-21-1 - Request For Assignment And Transfer Of Lien - Alabama Department Of Revenue Form Mvt-21-1 - Request For Assignment And Transfer Of Lien - Alabama Department Of Revenue Financial
Request For Approval And Authorization Of Overtime Request For Approval And Authorization Of Overtime Business
Request For Redaction And List Of Items To Be Redacted Request For Redaction And List Of Items To Be Redacted Legal
Form 01-135 - Vendor's Request For Refund And Assignment Of Right To Refund Form 01-135 - Vendor's Request For Refund And Assignment Of Right To Refund Financial
Form Mvt 21-1 - Request For Assignment And Transfer Of Lien - 1995 Form Mvt 21-1 - Request For Assignment And Transfer Of Lien - 1995 Financial
Form Dr-26rp - Florida Neighborhood Revitalization Program Application For Sales And Use Tax Form Dr-26rp - Florida Neighborhood Revitalization Program Application For Sales And Use Tax Financial

Related Categories

Parent category: Legal
Download
Go