APPLICATION FOR LEAVE - Amazon Web Services
|APPLICATION FOR LEAVE |AGENCY: Louisiana Delta Community College |
|SF-6 (R 12-04) | |
|Employee Name |I request |FROM: AM PM |TO: AM PM |
| |hours of leave. | | |
| | | | |
| | | / / | / / |
|Chargeable Leave Request |
|FMLA: LWOP |
|Annual Straight Compensatory Self |
| |
|Sick Time and One-Half Compensatory Family |
| |
|Unpaid |
|Non-Chargeable Leave Request EDUCATIONAL: SPECIAL: |
| |
|Funeral Job Related Act of God Office Closure |
|Jury Duty MILITARY: (max 15 days per year) Civil Air Patrol American Red Cross |
|Hazard Duty (law enf) Active Emergency Civilian Voting |
|Other Training |
|(Explain in “Comments” Section) Physical |
|Comments |
| |
| |
|I CERTIFY THAT MY ABSENCE FROM DUTY WAS FOR THE REASON NOTED |
|Employee Signature |Date |Approved by and Title |
| | | |
| | | |
|Leave Definitions |
|Absence Leave Request: | | |
|Annual: leave with pay granted an employee for the |Straight Compensatory: overtime leave earned by |FMLA: (Family and Medical Leave Act) approved absence |
|purpose of rehabilitation, restoration and |employees exempt from federal Wage and Hour laws |available to eligible employees for up to 12 weeks of |
|maintenance of work efficiency, or transaction of |when they have physically worked hours in excess of |leave per year for certain family and medical reasons. |
|personal affairs. |their regular schedule. | |
| | | |
|Sick: leave with pay granted an employee who is |Time and One-Half Compensatory: overtime leave |Self: for employee’s own serious health condition. |
|suffering with a disability which prevents him from |earned by employees who are non-exempt under federal| |
|performing his usual duties and responsibilities or |Wage and Hour laws when they have physically worked |Family: an immediate family member (spouse, child or |
|who requires medical, dental or optical consultation|hours in excess of their regular schedule. |parent) with a serious health condition. |
|or treatment. | | |
| |LWOP: Leave Without Pay |Unpaid: when paid leave (annual/sick) is exhausted or |
| | |cannot be used under specific circumstances. |
| | | |
|Non-Chargeable Leave Request: |EDUCATIONAL |Civil Air Patrol: a member of Civil Air Patrol ordered|
|Funeral: leave granted when attending the funeral |Job Related: leave granted to attend a course that |to perform duty with troops or participate in field |
|or burial rites of a parent, step-parent, child, |is relevant to job. |exercises or training. Leave shall not exceed 15 |
|step-child, brother, step-brother, sister, | |working days in any one calendar year. |
|step-sister, spouse, mother-in-law, father-in-law, |MILITARY (maximum 15 days per year) | |
|grandparent or grandchild; provided such time off |Active: leave granted when called to active |Emergency Civilian: performing emergency civilian duty|
|shall not exceed two days on any one occasion. |military duty. |in relation to national defense. |
| | | |
|Jury Duty: summoned to perform jury duty. |Training: annual training or active duty for |Office Closure: leave granted due to local conditions |
| |training (weekend drills). |which prevent the employee from attending work. |
|Hazard Duty (law enf): granted when an employee | | |
|engaged in law enforcement work is disabled while in|Physical: leave granted to conduct mandatory |American Red Cross: leave granted for a period not to |
|the performance of duty of a hazardous nature and |physical to enlist in military. |exceed 15 work days in any calendar year to participate|
|because of such disability is unable to perform his | |in American Red Cross relief services in Louisiana for |
|usual duties. (Civil Service Rule 11.21.1) |SPECIAL |disasters designated as Level III or above in the Am |
| |Act of God: appointing authority determines the |Red Cross Regulations and Procedures. Must be |
|OTHER |employee is prevented by an act of God from |certified as a Trained Disaster Volunteer and approved |
|Any other special or non-chargeable leave request as|performing duty. |by appointing authority. |
|provided in Chapter 11 of the C.S. Rules. | | |
| | |Voting: leave granted when voting in a primary, |
| | |general or special election which falls on regular |
| | |scheduled work days, provided not more than two hours |
| | |of leave shall be allowed to vote in the parish where |
| | |he is employed and not more than one day to vote in |
| | |another parish. |
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