REQUEST FOR LEAVE FORM – AFSCME MEMBERS ONLY

REQUEST FOR LEAVE FORM – AFSCME MEMBERS ONLY
Option 1: (Scan it)
Step one: (Employee) completes the form and signs it in pen;
Step two: (Manager) signs the form in pen, scans it and sends it electronically to the
attention of AFSCME-RFL@facilities.udel.edu. (HR Liaison/Timekeeper team);
Step Three: (Manager) provides a copy of the signed (approved) form to the employee.
Option 2: (Manual)
Step one: (Employee) completes the form and signs it in pen;
Step two: (Manager) signs the form in pen, makes a copy of the signed (approved)
form;
Step Three: (Manager) provides a copy of the signed (approved) form to the employee.
Step four: (Manager) sends the original form to the attention of Sheila Boyle or Kathy
Michael (to whoever is the designated HR Liaison/Timekeeper) via an inter-office
envelope or hand delivers the original document;
Step five: (Sheila or Kathy) scans the form and sends the original form back to the
designated manager for his/her records.
Printing the Form:
Please change Page Sizing under print options: Fit (see sample below: if problem printing)

NAME EMPL ID#
DEPARTMENT
REASON FOR ABSENCE: Sick No Pay Bereavement
Vacation
Emergency Vac
Comp Time Off
Sick Pay
LTI
Accident Paid
Accident Not Paid
Ex Absence
Jury Duty
Late No Pay
DEP CARE
FMLA
BEGINNING DATE BEGINNING TIME
AM PM
ENDING DATE ENDING TIME
REASON FOR ABSENCE: Sick No Pay
AM PM
Bereavement
Vacation
LTI
Jury Duty
Emergency Vac
Accident Paid
Late No Pay
Comp Time Off
Accident Not Paid
DEP CARE
Sick Pay
Ex Absence
FMLA
BEGINNING DATE BEGINNING TIME
AM PM
ENDING DATE ENDING TIME
COMMENTS
AM PM
PRINT EMPLOYEE NAME & SIGN DATE
SUPERVISOR/MANAGER'S SIGNATURE DATE
Revised 05/2012
HOURS
DAYS
HOURS
DAYS
FMLA NO PAY
FMLA Vac
Other
FMLA NO PAY
FMLA Vac
Other