Request for Leave Application
CURRENT DATE
*
/
Day
/
Month
Year
Date
EMPLOYEE NAME
*
Full name of person requesting vacation days
SUPERVISOR NAME
*
Name of your immediate supervisor
How many days are you applying for?
*
Enter the number of days being requested
LEAVE TYPE
*
Vacation
No-Pay
Compassionate
Paternity
VACATION START DATE
*
-
Day
-
Month
Year
Date
VACATION END DATE
*
-
Day
-
Month
Year
Date
EMPLOYEE SIGNATURE
*
SIGNATURE
SUPERVISOR SIGNATURE
FOR OFFICE USE ONLY
Total Entitlement
Total Requested
Balance
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