Leave Form

Employee:

Email:

I have made arrangements for coverage of any responsibilities or duties during my absence (walk-in hours, lunch coverage, presentations, etc.) Yes No

This leave request constitutes

Annual Leave (vacation time and personal time off.)

Sick Leave (includes personal doctor appointments, personal, dental appointments, and maternity related absences, family illness, etc.)

Professional Leave (time out of office for conferences, professional development, employer site-visits, etc. Is not subtracted from employees leave banks.)

Other (explain in comments)

Comments:

Summary by date:
  Leave Type Hours  

Partial Hours:

  1-6 min. = .1 hours
  7-12 min. = .2 hours
  13-18 min. = .3 hours
  19-24 min. = .4 hours
  25-30 min. = .5 hours
  31-36 min. = .6 hours
  37-42 min. = .7 hours
  43-48 min. = .8 hours
  49-54min. = .9 hours
 

for a total of

hours

55-60 =1.0 hours