WASHINGTON NORTHEAST
SUPERVISORY UNION
Leave Form
Name:
_______________________________ Position: ______________________________
Date Form is Prepared/Submitted:
_____________________
Note: All types of leave require advance
approval. Complete parts A &
B, sign part C and give to your
Supervisor. A copy will be returned to you for your
records.
A. Type of Leave (Use a
separate form for each different type of leave requested.)
Please Check One:
( ) Illness ( ) Self or ( ) Family Member
( ) Personal Explain:
______________________________________________________
______________________________________________________
( ) Field Trip ( ) Vacation ( ) Military
( ) Other Explain:
______________________________________________________
______________________________________________________
Professional Explain:
______________________________________________________
______________________________________________________
( ) Required Professional By
Whom:
__________________________________________
Explain:
______________________________________________________
______________________________________________________
B. Date and Time Requested
Full
Day(s) _________________________________
Half
Day(s) _________________________________ A.M.
or P.M. (Circle One)
C. EmployeeÕs Signature
________________________________________
Signature of Employee
D. Approvals
1. _____________________________________________
( ) Approved ( ) Denied
Signature of Principal or Supervisor Date
2.
Payroll:
Originally
Eligible for __________
Balance
Before this Request __________
Using
with this Request __________
Balance
Available if Needed __________
3.
_____________________________________________ ( ) Approved ( )
Denied
Signature of Superintendent
Date
Comments:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________