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5 views

Form C

c

Uploaded by

ffggfsgfsegr
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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UNIVERSITÉ D’OTTAWA

’ • UNIVERSITY OF OTTAWA

Request for leave / leave modification

Generate number C-

REQUEST FOR (COMPLETE SECTION A & C) REQUEST FOR LEAVE (COMPLETE SECTION B & C) REQUEST FOR (COMPLETE SECTION D)
ACADEMIC LEAVE WITH AND WITHOUT PAY LEAVE MODIFICATION

SURNAME (CANDIDATE) GIVEN NAMES EMPLOYEE NUMBER

FACULTY, SCHOOL DEPARTMENT

ACCOUNTING PLAN – FDM POSITION NUMBER FTE


FUND COST CENTER PROGRAM ACCOUNT

HIGEST DEGREE OBTAINED AND DATE


INSTITUTION LOCATION DIPLOMA YEAR

DATE OF HIRING ...................................................... DATE OF TENURE ..........................................


YEAR MONTH DAY YEAR MONTH DAY

REQUEST FOR LEAVE

A TYPE OF LEAVE
ACADEMIC LEAVE WITH A REQUEST
FOR A RESEARCH GRANT
ACADEMIC LEAVE WITHOUT A REQUEST
FOR A RESEARCH GRANT
PERIOD
OF LEAVE FROM TO
YEAR MONTH DAY YEAR MONTH DAY

DATE OF LAST CREDITS AVAILABLE CREDITS TO BE USED


ACADEMIC LEAVE FROM TO FOR THIS REQUEST FOR THIS REQUEST BALANCE
YEAR MONTH DAY YEAR MONTH DAY

SALARY WHILE ON ACADEMIC LEAVE


%
B TYPE OF LEAVE REQUESTED LEAVE WITH PAY SALARY WHILE ON LEAVE
% LEAVE WITHOUT PAY

PERIOD OF LEAVE FROM TO


YEAR MONTH DAY YEAR MONTH DAY

CONSEQUENCE OF LEAVE ON PTR RECOMMENDATION YES NO CONSEQUENCE OF LEAVE ON YULE RECOMMENDATION YES NO

FACULTY TPC RECOMMENDATION


C
POSITIVE

NEGATIVE

ATTACHED

DEAN’S RECOMMENDATION
POSITIVE

NEGATIVE

ATTACHED

DATE DEAN’S SIGNATURE

Administration and Governance


SECR-1078(E) PDF 2024/07
UNIVERSITÉ D’OTTAWA • UNIVERSITY OF OTTAWA

Request for leave / leave modification

LEAVE MODIFICATION

D C-
FROM TO
N° RÉF. :
ORIGINAL PERIOD OF LEAVE

YEAR MONTH DAY YEAR MONTH DAY


DEFERRED LEAVE
MODIFIED PERIOD OF LEAVE
YEAR MONTH DAY YEAR MONTH DAY

CANCELLATION OF LEAVE

THIS MODIFICATION WILL ENTAIL A CHANGE TO THE REQUESTED SALARY THIS MODIFICATION WILL ENTAIL A CHANGE TO THE REQUIRED CREDITS

SALARY WHILE ON LEAVE


% NUMBER OF CREDITS MODIFIED

DATE DEAN’S SIGNATURE

FOR ADMINISTRATION USE ONLY

Administration and Governance


SECR-1078(E) PDF 2024/07

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