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0 R $ $ $ Y _ _ - _ _ _ _ _ - _ _ _ _ _ _ _ $ _ _ _ _ _ _ _ _ _ : REQUEST FOR LEAVE: VACATION / OTHER
NameDateI would like to request time off as indicated below.Plan ahead. Please try to plan at least one week, and preferably one month, or more in advance.
Use CTO leave before vacation, since comp time must be used within 12 months of earning it.Leave type: FORMCHECKBOX Doctor/Dentist (charged to sick leave) FORMCHECKBOX Personal Necessity (charged to sick leave) FORMCHECKBOX Sick leave FORMCHECKBOX Vacation FORMCHECKBOX Well Day FORMCHECKBOX CTO (using accrued comp time) FORMCHECKBOX Personal holiday FORMCHECKBOX Other (specify):Date(s)Time# HoursFrom/To:From/To:Return to work on:Coverage by:Employee signatureDate:(circle one)APPROVEDDISAPPROVEDManagers signature:Date:
REQUEST FOR LEAVE: FURLOUGH Day(s)
FORMCHECKBOX Furlough Day(s) (See CSEA Side Letter Agreement for Guidelines)Date(s)Time# HoursFrom/To:From/To:Return to work on:
FILENAME \* Caps \* MERGEFORMAT FORM_Furlough_Request-To-Leave.Doc Revised 10/19/09
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