Leave Request for Hourly (Non-Exempt) Employees

See instructions for questions about completing this form.

PERSONAL INFORMATION First and Last Name (required): Email Address (required):

DATES/HOURS OF LEAVE

Recorded in 15 minute increments

From Date: From Time: To Date: To Time: Total Hours Requested:

LEAVE TYPE

Choose One:

Vacation Leave VAC | Hours and Dates:

Sick Leave SCK | Hours and Dates:

Parental Leave PLV | Hours and Dates:

Funeral Leave FNL | Hours and Dates:

Jury Duty JRY | Hours and Dates:

Military Leave MIL | Hours and Dates:

Leave Without Pay | Hours and Dates:

Discretionary Day DDY | Date:

Compensatory Time CMT | Hours and Dates:

Holiday Compensatory Time HCT | Hours and Dates:

Other Leave
Type, Hours and Dates:

*Other Leave: Disaster Leave-DIS, Donor Leave-DON, etc.

REASON Reason for Leave / Other Absence:

SUPERVISOR Supervisor's Email (required):

DEPARTMENT TIMEKEEPER Timekeeper's Email (required):

-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --

This form may not work on all devices.

Signatures only required if printing request instead of submitting online.

Employee's Signature: Date: Supervisor's Signature: Date:

KSU Policy and Procedures Manual Chapter: