Leave Time Request Form - Edelmann
***Please completely fill out the form below*** |
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Employee Name: | ||
Employee E-mail: | ||
UF ID #.: | ||
Supervisor E-mail: |
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Department: | Microbiology and Cell Science | |
Role with the department | ||
FMLA-Qualifying Event? | ||
Leave Date: | ||
Leave Time: | ||
Return Date: | ||
Return Time: | ||
Total Hours Absent: | ||
Type and Amount of Leave | ||
Type and Amount of Administrative Leave | ||
Type of FMLA Event (If Applicable) | ||
Leave Without Pay | ||
December Vacation Leave Cash-Out | ||
Personal Leave Days | ||
I certify that my absence is for the reason stated above and I understand that my absence will count toward my 12 workweeks of FMLA entitlement if absence is for a qualifying event. (See notice for more information.) |
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Electronic Signature : | Date: | |