Employee Request for Leave

DNR SOP – HR605 Attachment #1

GEORGIA DEPARTMENT OF NATURAL RESOURCES

EMPLOYEE REQUEST FOR LEAVE

Employee Name: Employee ID:
REQUEST TO USE ACCRUED LEAVE / COMPENSATORY TIME / HOLIDAY DEFERRAL / ADMINISTRATIVE LEAVE
Administrative Leave
Holiday Deferral Blood Donation Leave
Compensatory Time: FLSA State Court Leave (Subpoena/summons for jury duty or other court order is required. Send to OHR.)
NOTE: Holiday Deferral and FLSA Compensatory Time Education Support Leave (Documentation required.)
MUST be used prior to requesting any of the following Military Leave (Attach copy of military orders.) (For extended ML, see below**.)
types of leave: Voting Leave
Annual Leave Other Administrative Leave* Specify:
Personal Leave*Other Administrative Leave types must be approved by the DNR HR Director.
Sick Leave Reason for using Sick Leave
(Doctor's certification may be required for Sick Leave.)
Dates of Absence:From – Date: / / Time: a.m. p.m.
To – Date: / / Time: a.m. p.m.
Number of Days Requested Number of Hours Requested:
Note: Certain types of absences will require Family & Medical Leave paperwork. See Standard Operating Procedure HR608 for information.
REQUEST FOR LEAVE WITHOUT PAY – APPOINTING AUTHORITY REVIEW IS REQUIRED
Short-term LWOP Regular LWOP Contingent LWOP FML w/o Pay ML w/o Pay (Attach copy of military orders.)
(For extended ML & Contingent
Reason for Absence: Personal Illness or Disability Personal Convenience Leave, see** below.)
(Attach doctor’s certificate.)
Other Reason (Explain):
Dates of Absence:From – Date: / / Time: a.m. p.m.
To – Date: / / Time: a.m. p.m.
Number of Days Requested: Number of Hours Requested:
LEAVE REQUEST APPROVAL/DISAPPROVAL
Approved Disapproved - Comment: ______
Supervisor’s Signature: ______Date: ______
Approved Disapproved - Comment: ______
Additional Authorized Signature (as required): ______Date: ______
Approved Disapproved - Comment: ______
Appointing Authority’s Signature (as required): ______Date: ______
______
**Action by HR Director – only for approval of extended (more than ten continuous work days/2 weeks) Military Leave, and Contingent Leave w/o Pay
Approved Disapproved - Comment: ______
HR Director’s Signature: ______Date: ______
Instructions: This form is to be completed by the employee and approved by the supervisor prior to the absence from work (Except in cases of emergency). Employees are responsible for determining they have sufficient leave by checking their leave balances through Employee Self Service at http://team.georgia.gov before submitting a leave request. Failure to obtain leave approval may result in unauthorized leave without pay and/or disciplinary action.
Employee’s Signature: ______Date: ______

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