7/29/2010

Approval for Absence

Department of Pediatrics

Faculty/Staff: ______Division: ______

I plan to be absent on (list dates): ______

I will use time accrued from  MCVP  VCU

For one of the following:

MCVP VCU

  PTO ______hr’s  Annual ______hr’s

  Education ______hr’s  Sick ______hr’s

  Jury Duty ______hr’s  Family Sick ______hr’s

 Personal Family ______hr’s

 Community Service ______hr’s

 Compensatory ______hr’s

 Holiday ______hr’s

 Overtime Leave ______hr’s

Additional Information:

Approved

Signature Date Division Chair / Supervisor Date

Approved

Departmental Timekeeper Date

Leave Balance ______Approved

Administrator Date

Approved

Department Chair Date

Departmental Guidelines

  • This form is to be completed by each faculty/staff member and approved in advance of absences.
  • Requests must be submitted 30 days prior (planned) or as soon as possible (unplanned).
  • Submit to your Division Chair / Supervisor first and then to the Departmental Timekeeper:

VCU: Calcine Harris 827-1475

MCVP: Wanda Peebles 828-8958

  • The form will then be forwarded to the Departmental Administrator.
  • This form will remain on file in Pediatric Administration.
  • Leave is not approved until signed by the Administrator.
  • You may request your leave balance at any time from the Departmental Timekeeper.

VCU: Calcine Harris 827-1475

MCVP: Wanda Peebles 828-8958