Leave Request

Directions

Complete the form below to request time off from your regularly scheduled hours. Leave requests for ANNUAL leave should be submitted to the Personnel Department at least two weeks before the requested time off. Leave is not approved unless you receive a printed copy of this form indicating the approval from both the Personnel Department and the Supervisor of Support Services or Director. SICK leave requests must be submitted within 48 hours after the leave occurred. (Part-time employees do not receive paid time off. Part-time staff should simply indicate their status as such.)

Your Name: Name of person completing this form.

Your Email Address: Valid email address is required. An email confirmation will be sent to the email address above for your records. If you do not have an email address, please input the email address of your primary work location.

Location 1: Select a location for which you are requesting leave
Enter the hours & schedule for the requested leave at the above location.

Location 2: Select a location for which you are requesting leave
Enter the hours & schedule for the requested leave at the above location.

Location 3: Select a location for which you are requesting leave
Enter the hours & schedule for the requested leave at the above location.

Location 4: Select a location for which you are requesting leave
Enter the hours & schedule for the requested leave at the above location.

Location 5: Select a location for which you are requesting leave
Enter the hours & schedule for the requested leave at the above location.

Job Title: Select your job title.

Hire Date: Select the month and year of your hire date.

Type of Leave Requested: Select the type of leave requsted.

Total Hours Requested: Enter the total hours requested from all locations.

Enter Your Leave Balance:
Full Time Only Enter the sick or annual leave balance.

If you do not have sufficient paid time off to cover the amount of hours requested, you will need to submit a letter of request to your Department Director.

Comments List any comments or other informaiton as needed:

Submit the form After you hit the submit button you will see an on screen confirmation showing the information that you entered. Please print or save the next screen for your reference.