LEAVE REQUEST FORM - Download as DOC by b898L2T

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									                                                                                                                          Form 204
                                                                                                                         V20110822




                                             LEAVE REQUEST FORM

 I request                  hours of
        (number of)                      (see list below *)

 from                                            to
           (time & date)                               (time & date)




I certify that sufficient leave is available to cover this absence (annual and sick leave only).



                                                         Employee’s Signature


                                                        Print Name


 Justification, if applicable:




    Approved
    Disapproved



 (supervisor’s signature)                               (date)



        * Types of Leave include:
               Annual Leave
               Sick Leave
               Administrative Leave
               Military Leave
               Leave Without Pay
               Floating Holiday




                    Please return completed form to your Program Manager/Supervisor.
               6720-A Rockledge Drive · Suite 100 · Bethesda, Maryland 20817 · Telephone: (240) 694-2000 · www.hjf.org

								
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