"Employee Leave of Absence Request Form"

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LEAVE OF ABSENCE REQUEST FORM
DATE(S) REQUESTED
HOURS UNAVAILABLE
TYPE OF LEAVE
__________________________
___TO ___
______ PAID
__________________________
___TO ___
______ UNPAID
__________________________
___TO ___
______ SICK
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
NOTE: IF HOURS GO INTO MORE THAN ONE PAY PERIOD, PLEASE COMPLETE A FORM FOR EACH PERIOD.
TOTAL NUMBER OF HOURS REQUESTED
_____________
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________
EMPLOYEE’S SIGNATURE
_____________________________________________
EMPLOYEE’S NAME PLEASE PRINT
LEAVE APPROVED
____
___________________
LEAVE DENIED
____
DATE
______________________________
SUPERVISOR’S SIGNATURE
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
LEAVE OF ABSENCE REQUEST FORM
DATE(S) REQUESTED
HOURS UNAVAILABLE
TYPE OF LEAVE
__________________________
___TO ___
______ PAID
__________________________
___TO ___
______ UNPAID
__________________________
___TO ___
______ SICK
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
__________________________
___TO ___
NOTE: IF HOURS GO INTO MORE THAN ONE PAY PERIOD, PLEASE COMPLETE A FORM FOR EACH PERIOD.
TOTAL NUMBER OF HOURS REQUESTED
_____________
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________
EMPLOYEE’S SIGNATURE
_____________________________________________
EMPLOYEE’S NAME PLEASE PRINT
LEAVE APPROVED
____
___________________
LEAVE DENIED
____
DATE
______________________________
SUPERVISOR’S SIGNATURE
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________