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
DEPARTMENT DIVISION
DATE SUBMITTED PREPARED BY DATE OF LAST REQUEST 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 * ATTACH SUM M ONS
MILITARY LEAVE * ATTACH ORDERS
OTHER (EXPLAIN BELOW)
.
EMPLOYEE > DATE 8/23/2007
SUPERVISOR > DATE
APPROVING > DATE
* Supporting document (s) F&A 019 REV. 7/91
must accompany this form 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 124240
DEPARTMENT DIVISION
Human Resources Communications
DATE SUBMITTED PREPARED BY DATE OF LAST REQUEST REASON
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 *SECT 12-169 PAR F.1
CIVIL SERVICE CODE OF ORDINANCE
ABSENT
DEATH IN FAMILY
COMP. TIME
JURY DUTY * ATTACH SUM M ONS
MILITARY LEAVE * ATTACH ORDERS
OTHER (EXPLAIN BELOW)
EMPLOYEE > DATE 11/19/2004
SUPERVISOR > DATE
APPROVING > DATE
* Supporting document (s) F&A 019 REV. 7/91
must accompany this form 7530-0100377-00
CATEGORY USAGE From To
Wellness 0 hrs 1-Sep Present
Sick 0 hrs 1-Sep Present
Vacation 0 hrs 1-Jan Present
Emer.Vac 0 hrs 3-Sep Present
Personal 0 hrs 1-Sep Present
Floater 0 hrs 1-Jan Present