Leave Request Form

Academic Affairs - 12-Month Employees

UCA Academic Affairs Leave Request Form: 12-Month Employees
Employee's Name*
UCA ID #*
Start Date of Leave (First day not working)*
End Date of Leave (Last Day not working)*
Total leave hours used during this period*
Purpose of Leave*
- Vacation
- Sick
- Comp Time
- Children's Education (8 hrs max per year)
THIS SECTION FOR USE IF TWO TYPES OF LEAVE TAKEN DURING PAYPERIOD.
Example: You used 8 hrs Vacation and 8 hrs Sick during same period.
Start Date of Leave (First day not working)
End Date of Leave (Last Day not working)
Total leave hours used during this period
Purpose of Leave
- Vacation
- Sick
- Comp Time
- Children's Education (8 hrs max per year)
By entering name, date and time below you are confirming these entries and your signature.*
First Last
Date*
Supervisor Signature/Approval