Shoreline Community College Faculty Request For/report of Leave
Uploaded by
Zimbo KigoShoreline Community College Faculty Request For/report of Leave
Uploaded by
Zimbo KigoShoreline Community College Faculty Request for/Report of Leave
Employees Name (Last, First)
Leave Type [Code]
[ S ] Personal (Sick) Leave
Employee illness, injury, bereavement Home demands (recent paternity, child adoption, emergencies) Disability* Family* (care for a child/immediate family member)
SID# 965[ M ] Military (attach orders) [ J ] Jury Duty/Subpoena (attach summons) [ PD ] Personal Day*
(maximum one day per quarter) Cant be used for holiday or recreational purposes or for gainful employment or self-employment.
Dept. Ext. No.
[ PL ] Professional Leave* [ LW ] Leave of Absence Without Pay* [ FM ] Family Medical Leave*
Submit FML request to HR prior to taking leave if possible. * THESE LEAVE TYPES REQUIRE PRIOR REVIEW/APPROVAL
Directions: Enter below the appropriate Leave Type Code (listed above) for each day of leave requested/taken. For absences of less than a full day, 1) instructional academic employee: divide number of contact hours (c/h) missed by number of c/h scheduled for that day (e.g. 2 c/h missed divided by 3 c/h total = 0.67 day); if absence due to sickness is on a contract day with no scheduled c/h, compute percentage missed on basis of 7-hour day, 2) non-instructional academic employee: compute percentage of day missed on basis of 7-hour day, 3) associate academic employee: report each full day missed on basis of quarterly % of full-time load, e.g., if quarterly teaching assignment is 67% f.t., report 1 days absence as 0.67 day; if 1 class out of 2 scheduled is missed, report 0.33 day.
Month/Year
1 16
2 17
3 18
4 19
5 20
6 21
7 22
8 23
9 24
10 25
11 26
12 27
13 28
14 29
15 30 31
Leave Type [Code] Enter total days of leave, or % of day(s), taken by type: For example: S = .67 (missed 2 of 3 classes; or PD = l Does any absence entered above include moonlight assignment? If YES, specify leave type, % of load (e.g. S= .33 ) & date(s):
Total Days Taken
= = =
Date(s)
Employees Signature Approved Disapproved (Explain)
Date
___________________________________________
Human Resources Office Approval Date
Supervisors Signature Human Resources/Payroll Office Use Only:
Date
HR/Payroll Input (LWOP, ADJ)
Date
