Attachment 1 "Leave Pool Request Form - Sample" - South Carolina

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What Is Attachment 1?

This is a legal form that was released by the South Carolina Department of Disabilities and Special Needs - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 17, 2019;
  • The latest edition provided by the South Carolina Department of Disabilities and Special Needs;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Attachment 1 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Disabilities and Special Needs.

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Download Attachment 1 "Leave Pool Request Form - Sample" - South Carolina

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SC DEPARTMENT OF DISABILITIES AND SPECIAL NEEDS
LEAVE POOL REQUEST FORM
Employee Section:
Name:
Personnel Number:
Division/Regional Center/Central Office:
Home Address
:
(include zip code)
Work Phone:
Cell Phone:
Email Address:
I am scheduled to work:
hours a day
days a week
I request:
Sick Leave Hours
or
Annual Leave Hours
Reason for Request: (Reason/details, illness, injury or personal)
Leave history:
:
(Please explain why you do not have sufficient leave to cover this request)
I have read the DDSN Leave Transfer Pool Directive (413-07-DD), and I understand that if my request for
leave is approved, I am subject to the terms of the DDSN Leave Transfer Program guidelines and any unused
leave will be returned to the Leave Pool Program. I understand that I must also comply with all other DDSN
Policies and Procedures regarding leave with or without pay.
Employee Signature:
Date:
Human Resources Section:
Class/Position:
Salary Rate:
Hourly Rate:
Director of Human Resources Signature:
413-07-DD (NEW 12/17/19)
Attachment 1
SC DEPARTMENT OF DISABILITIES AND SPECIAL NEEDS
LEAVE POOL REQUEST FORM
Employee Section:
Name:
Personnel Number:
Division/Regional Center/Central Office:
Home Address
:
(include zip code)
Work Phone:
Cell Phone:
Email Address:
I am scheduled to work:
hours a day
days a week
I request:
Sick Leave Hours
or
Annual Leave Hours
Reason for Request: (Reason/details, illness, injury or personal)
Leave history:
:
(Please explain why you do not have sufficient leave to cover this request)
I have read the DDSN Leave Transfer Pool Directive (413-07-DD), and I understand that if my request for
leave is approved, I am subject to the terms of the DDSN Leave Transfer Program guidelines and any unused
leave will be returned to the Leave Pool Program. I understand that I must also comply with all other DDSN
Policies and Procedures regarding leave with or without pay.
Employee Signature:
Date:
Human Resources Section:
Class/Position:
Salary Rate:
Hourly Rate:
Director of Human Resources Signature:
413-07-DD (NEW 12/17/19)
Attachment 1
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