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Vac-Sick Leave Request

This document is a vacation-sick leave request form for Georgia Institute of Technology employees. It provides instructions for requesting paid vacation or sick leave and notes documentation requirements. It collects information like the employee name, ID, department, type of leave requested, and dates. Supervisor and higher-level approval is also part of the process.

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Sivakumaran Kandasamy
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199 views1 page

Vac-Sick Leave Request

This document is a vacation-sick leave request form for Georgia Institute of Technology employees. It provides instructions for requesting paid vacation or sick leave and notes documentation requirements. It collects information like the employee name, ID, department, type of leave requested, and dates. Supervisor and higher-level approval is also part of the process.

Uploaded by

Sivakumaran Kandasamy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Georgia Institute of Technology

VACATION—SICK LEAVE REQUEST FORM


(OHR Policy Section 2.0)
http://www.admin-fin.gatech.edu/human/attendance/020100.html

This form must be submitted before taking leave.

Sick Leave Exception:


When accident or illness prevents filing a request before using leave, submit this form immediately upon return to work.

PLEASE TYPE OR PRINT

________________________________ ___________________ _______________________________


Name Employee ID# (PeopleSoft) Work Unit/Department

I request that I be granted PAID VACATION OR SICK LEAVE as follows:


_____ Vacation Leave (No documentation required. Simply write in: "Vacation" or "Day Off" in space below.)

_____ Sick Leave (No documentation is required for the first 5 consecutive days*, unless the manager
requests special documentation.
For routine use, simply write in: "Doctor Appointment" or "Illness" or "Injury" or
"Bereavement" in space below.)
NOTE: *Per Board of Regents Policy, a Doctor's certificate is required for Sick Leave use after 5 consecutive days.

NOTE: Time taken as Sick Leave (or Paid or Unpaid Leave of Absence) may be credited against Family Medical Leave Act eligibility.

Please grant this leave request as a result of the following circumstances. (Provide appropriate & adequate details.)
_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Give specific times for each type of leave requested and attach appropriate documentation as noted above.

____________________________________ _______________ _________ ____________ _ ______


Type of Leave Requested Beginning Date and Time Ending Date and Time

____________________________________ _______________ _________ ____________ _ ______


Type of Leave Requested Beginning Date and Time Ending Date and Time

Employee Signature ___________________________________ Date __ ________________________

_________________________________ ___________ [ ] Approved [ ] Disapproved


Supervisor's Signature Date
If approval is NOT recommended, attach explanation.

_________________________________ ___________ [ ] Approved [ ] Disapproved


Dean, Department Head, AVP or President Date
(If Required) If approval is NOT recommended, attach explanation.

VACATION – SICK LEAVE REQUEST FORM JUNE 2003

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