St. Helena Parish School District

REQUEST FOR LEAVE FORM
This form MUST be completed when any leave time is requested. In addition, the employee MUST submit their leave request in Netchex. Failure to complete this process will result in delayed leave without pay until proper documentation is provided. Please print the form once complete and submit to your administrator/immediate supervisor.
Name of Employee
Position
Job site:

SHELCSHATASHCCACentral Office
Type of leave requested (select one).
Beginning date of leave

MonthDayYear
Date
Ending date of leave

MonthDayYear
Date
Beginning time of leave.
Ending time of leave.
Amount of time for Request for Leave in hours.
Total number of Request for Leave in days
Explanation of Leave
Employee Signature

Clear
Date

MonthDayYear
Date
Should be Empty: