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Name
KENNESAW STATE UNIVERSITY
LEAVE REQUEST / REPORT FORM
For The Month of                          , 20
PRIOR APPROVAL OF LEAVE
Dept
Date
DEPT. HEAD SIGNATURE (DATE)
DIRECTIONS: Record the number of HOURS leave taken in the day-of-the-month and code block provided, under the appropriate type of leave heading; add each by code and total at right (DO NOT WRITE IN DAYS COLUMN).
NOTE: This form to be completed for all leave and any absence from work except regularly scheduled holidays and compensatory time off for overtime worked.
Personnel Action Form must be filed if employee's pay is affected.

VACATION LEAVE

Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
HRS
DAYS
V
 
                                                                 
PB
 
                                                                 
UA
 
                                                                  

V = Vacation       PB = Personal Business        UA = Unexused Absence (Determined by Supervisor)

COMMENTS:
TOTAL
    

SICK LEAVE

Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
HRS
DAYS
SS
 
                                                                 
SF
 
                                                                 
DF
 
                                                                 

SS = Sickness - Self (Doctor's Appt. etc.)             SF = Sickness - Family           DF = Death Family

COMMENTS:
TOTAL
    

OTHER ABSENCE

Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
HRS
DAYS
LA
 
                                                                 
JD
 
                                                                 

LA = Leave of Absence            JD = Jury Duty

COMMENTS:
TOTAL
    
 
 
 
Employee's Signature (Date)
Supervisor's Signature (Date)