Request For Leave

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REQUEST FOR LEAVE
(DD 230.44)
NAME:
LOCATION:
(Print or Type)
(Div, Bur, Armory, etc.)
PERIOD:
From:
To:
No. of Hours:
TYPE:
Vacation
Sick
Admin
Leave without pay
(1) See Below
Military
Other
PB
(2) Attach Orders
(3) Explain Below
(Supervisor’s Signature)
(Employee Signature)
Timekeepers Name/Phone Number (Print or Type)
NJDMAVA Form 101 - 30 November 2001
NOTE: ALL APPROVED LEAVE REQUEST FORMS MUST BE FORWARDED TO YOUR HUMAN RESOURCES OFFICE
Medical evidence is required for periods of five (5) or more days of Sick
Leave; or for any periods after an aggregate of fifteen (15) days of Sick
Leave used in one calendar year.
During this leave, I certify that I was:
Ill
In attendance of an ill member of my immediate family
Explanations or Remarks:

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