Fall 2022 COVID-19 CAMPUS-WIDE GUIDELINES

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Leave-Request-Form

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LEAVE INFORMATION

Section 1

Section 2

LEAVE TYPE*

LEAVE PERIOD

Section 3

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Instructions

  1. Employee must Complete Sections 1 and 2 then sing and date in Section 3.
  2. Supervisor must sign and date Section 3.
  3. Supervisor will give employees a copy of approval leave form.
  4. Attach to payroll certification, if leave taken. and forward to all payroll office.
  5. If no leave is taken, Please destroy this form .
  6. Maintain three(3)copies -one for employees,one for supervisor , and one to attach to payroll certification.
    MM slash DD slash YYYY
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