EMPLOYEE REQUEST FOR LEAVE - Intranet Department of ...



GEORGIA DEPARTMENT OF NATURAL RESOURCESEMPLOYEE REQUEST FOR LEAVEEmployee Name: FORMTEXT ?????Employee ID: FORMTEXT ?????REQUEST TO USE ACCRUED LEAVE / COMPENSATORY TIME / HOLIDAY DEFERRAL / ADMINISTRATIVE LEAVEAdministrative Leave FORMCHECKBOX Holiday Deferral FORMCHECKBOX Blood Donation Leave FORMCHECKBOX Compensatory Time: FORMCHECKBOX FLSA FORMCHECKBOX State FORMCHECKBOX Court Leave (Subpoena/summons for jury duty or other court order is required. Send to OHR.)NOTE: Holiday Deferral and FLSA Compensatory Time FORMCHECKBOX Education Support Leave (Documentation required.)MUST be used prior to requesting any of the following FORMCHECKBOX Military Leave (Attach copy of military orders.) (For extended ML, see below**.)types of leave: FORMCHECKBOX Voting Leave FORMCHECKBOX Annual Leave FORMCHECKBOX Other Administrative Leave* Specify: FORMTEXT ????? FORMCHECKBOX Personal Leave*Other Administrative Leave types must be approved by the DNR HR Director. FORMCHECKBOX Sick Leave Reason for using Sick Leave FORMTEXT ?????(Doctor's certification may be required for Sick Leave.)Dates of Absence:From – Date: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ???? Time: FORMTEXT ????? FORMCHECKBOX a.m. FORMCHECKBOX p.m.To – Date: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ???? Time: FORMTEXT ????? FORMCHECKBOX a.m. FORMCHECKBOX p.m.Number of Days Requested FORMTEXT ????? Number of Hours Requested: FORMTEXT ?????Note: Certain types of absences will require Family & Medical Leave paperwork. See Standard Operating Procedure HR001 for information.REQUEST FOR LEAVE WITHOUT PAY – APPOINTING AUTHORITY REVIEW IS REQUIRED FORMCHECKBOX Short-term LWOP FORMCHECKBOX Regular LWOP FORMCHECKBOX Contingent LWOP FORMCHECKBOX FML w/o Pay FORMCHECKBOX ML w/o Pay (Attach copy of military orders.)(For extended ML & ContingentReason for Absence: FORMCHECKBOX Personal Illness or Disability FORMCHECKBOX Personal Convenience Leave, see** below.)(Attach doctor’s certificate.) FORMCHECKBOX Other Reason (Explain): FORMTEXT ?????Dates of Absence:From – Date: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????Time: FORMTEXT ????? FORMCHECKBOX a.m. FORMCHECKBOX p.m.To – Date: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????Time: FORMTEXT ????? FORMCHECKBOX a.m. FORMCHECKBOX p.m.Number of Days Requested: FORMTEXT ?????Number of Hours Requested: FORMTEXT ?????LEAVE REQUEST APPROVAL/DISAPPROVAL FORMCHECKBOX Approved FORMCHECKBOX Disapproved - Comment: _______________________________________________________________________Supervisor’s Signature: _______________________________________________________________ Date: ____________________ FORMCHECKBOX Approved FORMCHECKBOX Disapproved - Comment: _______________________________________________________________________Additional Authorized Signature (as required): _____________________________________________ Date: ____________________ FORMCHECKBOX Approved FORMCHECKBOX Disapproved - Comment: _______________________________________________________________________Appointing Authority’s Signature (as required): ______________________________________________ Date: ___________________________________________________________________________________________________________________________________**Action by HR Director – only for approval of extended (more than ten continuous work days/2 weeks) Military Leave, and Contingent Leave w/o Pay FORMCHECKBOX Approved FORMCHECKBOX Disapproved - Comment: _______________________________________________________________________HR Director’s Signature: ______________________________________________________________Date: ____________________Instructions: This form is to be completed by the employee and approved by the supervisor prior to the absence from work (Except in cases of emergency). Employees are responsible for determining they have sufficient leave by checking their leave balances through Employee Self Service at before submitting a leave request. Failure to obtain leave approval may result in unauthorized leave without pay and/or disciplinary action.Employee’s Signature: __________________________________________________ Date: _________________________________ ................
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