Request For Leave

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Reques t for Leave

Name:_________________________ Date: __________

Name:_________________________ Date: __________


Type of Leave: Sick: ___ Annual: ___ LWOP: ___

Type of Leave: Sick: ___ Annual: ___ LWOP: ___


Start Date: Hour AM / PM Date
_____:_____ __________
Start Date: Hour AM / PM Date
_____:_____ __________
End Date: Hour AM / PM Date
_____:_____ __________
End Date: Hour AM / PM Date Total Hours of Leave: __________
_____:_____ __________

Total Hours of Leave: __________ Duties During My Absence Will Be Handled By:

Duties During My Absence Will Be Handled By: _____________________________________________

Signature: ____________________________________
_____________________________________________
Approval: Supervisor: _________________________
Signature: ____________________________________
Date: ______________________________
Approval: Supervisor: _________________________

Date: ______________________________

Re quest for Leav e

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