REVISED P.D. FORM 206 NOVEMBER 17, 1982
CITY OF HOUSTON
Leave Authorization Request
FORM DATA - FI L L I N APPROPRI ATE I NFORM ATI ON
EMPLOYEE NAME DEPARTMENT DATE SUBMITTED PREPARED BY DIVISION DATE OF LAST REQUEST
EMPLOYEE NUMBER
REASON
ACTI ON DATA - FI L L I N APPROPRI ATE I NFORM ATI ON
ACTION ACTION
BEGIN
END
NUMBER OF WORK DAYS
HRS
*
VACATION FMLA
*
SICK LEAVE FMLA
*SECT 12-169 PAR F.1
SICK LEAVE EXTENSION
CIVIL SERVICE CODEOF ORDINANCE
*
ABSENT FMLA FLOATING HOLIDAY DEATH IN FAMILY COMP. TIME JURY DUTY MILITARY LEAVE OTHER (EXPLAIN BELOW)
* ATTACH SUM M ONS * ATTACH ORDERS
.
EMPLOYEE
>
DATE DATE DATE
* Supporting document (s) must accompany this form
8/23/2007
SUPERVISOR > APPROVING >
F&A 019 REV. 7/91 7530-0100377-00
REVISED P.D. FORM 206 NOVEMBER 17, 1982
CITY OF HOUSTON
Leave Authorization Request
FORM DATA - FI L L I N APPROPRI ATE I NFORM ATI ON
EMPLOYEE NAME
EMPLOYEE NUMBER
David Schafer
DEPARTMENT DIVISION
124240 Communications
PREPARED BY DATE OF LAST REQUEST REASON
Human Resources
DATE SUBMITTED
9-Dec-04
Dave Schafer
none
Vacation
ACTI ON DATA - FI L L I N APPROPRI ATE I NFORM ATI ON
ACTION ACTION
BEGIN
END
NUMBER OF WORK DAYS
HRS
VACATION
2
7
05
2
11
05
5
40
SICK LEAVE SICK LEAVE EXTENSION ABSENT
*SECT 12-169 PAR F.1 CIVIL SERVICE CODE OF ORDINANCE
DEATH IN FAMILY COMP. TIME JURY DUTY MILITARY LEAVE OTHER (EXPLAIN BELOW)
* ATTACH SUM M ONS * ATTACH ORDERS
EMPLOYEE
>
DATE DATE DATE
* Supporting document (s) must accompany this form
11/19/2004
SUPERVISOR > APPROVING >
F&A 019 REV. 7/91 7530-0100377-00
CATEGORY Wellness Sick
USAGE
From
To Present Present
Vacation
Emer.Vac Personal Floater
0 hrs 0 hrs 0 hrs 0 hrs 0 hrs 0 hrs
1-Sep 1-Sep 1-Jan 3-Sep 1-Sep 1-Jan
Present
Present Present Present