Series 403.3.1.4.2P - Transportation Employee Request for Leave of Absence of More Than Two Days

 

I,________________________________________, #________________ request permission to be

                                   (print name)                                          (employee number)

absent from my regular duties:  AM_____ NOON_____ PM_____ Activity_____ Other_____

Dates of requested leave:   Circle  ( M   T   W   Th   F )

from ______________________________________ through______________________________

                           month-day-year                                                                    month-day-year

Reason for leave_______________________________________________________________

_____________________________________________________________________________

 

Check:

_____ Driver (Bus #'s)__________________________________________________________

_____ Chaperone (Bus #'s)______________________________________________________

_____ Crossing Guard (Location)________________________________________________

                                                          AM

Time & date of request   _______________PM______________________

Employee signature: _______________________________________

 

Logged_______ Approved_______ Disapproved_______ 

By __________________________________      By __________________________________

(Coordinator of Transportation or Designee)         (Human Resources)

Procedures/403.3.1.4.2P/3-15-04