Mercer University School of Medicine

Mercer Medicine

Department Leave Request/Approval Form for Faculty/Provider
Leave Request must be submitted to Supervisor 10 working days in advance.

(Leave is not approved until signed by Department Chair.)
Employee Name:*

First NameLast Name
Email*
example@example.com
Location*
Request for Leave (Please indicate type):*
Is this leave all day:*
Starting Date*

MonthDayYear
Date
Ending Date*

MonthDayYear
Date
Scheduled times to block:

Hour Minutes

AM/PM Option
Hour Minutes

AM/PM Option
Total number of hours being requested:
Please remember to also enter your vacation time in WorkDay.
Sick Leave
Please indicate type.
Unpaid Leave
Purpose of unpaid leave
If required covering physicians name:
Covering physicians email address:
example@example.com
File Upload

Cancelof
Should be Empty:

Mercer Medicine