Leave Request Form - Ranger College
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1L
R
F
EAVE
EQUEST
ORM
Employee Name:
Title:
Primary Location:
Date:
Please mark next to the appropriate type of leave.
Sick Leave*
Vacation Leave**
Personal Leave (16 hours annually)
Bereavement
Workers Comp
Other
Date(s) of Leave
(mm/dd/yy): ___________________through__________________________
Please indicate dates and hours for each day in the comment section below
Monday
Date
Hours
Type of Leave
Tuesday
Date
Hours
Type of Leave
Wednesday
Date
Hours
Type of Leave
Thursday
Date
Hours
Type of Leave
Friday
Date
Hours
Type of Leave
Total number of hours missed:
Employee’s Signature:
_______
Date:
Supervisor’s Signature:
_______
Date: __________________
VP Administrator’s Signature: ________________________
Date: __________________
NOT
President’s signature required if
submitted within 24 hours of returning to work.
President’s Signature: _______________________________
Date: ___________________
* Sick Leave accumulates up to 480 hours.
** Vacation Leave accumulates up to 160 hours.
Please note not all employees are eligible for vacation accrual.
All vacation taken between the dates of August 15
th
– May 15
th
is subject to approval by the President.
For questions pertaining to the leave policies, please contact:
Human Resources at 254-647-3234 ext. 7037
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Parent category: Business