Leave Of Absence Form

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Leave of Absence Form
Applicant Name:
Date of Filing:
Organization:
Department:
SSN:
Purpose for Leave:
Dates of Leave:
From:
To:
Number of Days:
Inclusive Days:
Type of Leave
Annual Leave
Sick Leave
Compensatory Time Off
Unpaid Absence
Other:
Additional Remarks:
To Be Filled Out by Management
Approved
Disapproved
Reason for disapproval:
Supervisor Signature
Date

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