Leave Time Request Form - Oli

***Please completely fill out the form below***

Employee Name:
Employee E-mail:
UF ID #.:
Supervisor E-mail:
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.)
Electronic Signature : Date: