Series 403.3.1.4.2P - Transportation Employee Request for Leave of Absence of More Than Two Days
Adopted: May 1980
Revised: March 2004
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