ANNUAL LEAVE REQUEST
 

Begin Date:	(ex. 03/06/02)	End Date:
Total Hours:

SICK LEAVE
 

Begin Date:	(ex. 03/06/02)	End Date
Total Hours:
Reason for Absence:

This form is to be completed by all exempt employees prior to an absence from campus for Annual Leave and immediately upon return for Sick Leave. If sick leave is claimed for a continuous period in excess of one week, more than forty continuous hours, a physician's statement is required to permit further claim of sick leave rights by the employee-patient. If desired, a photocopy may be made for your records. The completed form should be mailed to the Human Resources Office.
 

AUTHORIZATION

Requested By ____________________________________________________

Employee Signature

Date

Approved By _____________________________________________________

Supervisor's Signature

Date