Request For Leave Form Rev. 1 (07/15/2009)

CITY OF EAGLE PASSREQUEST FOR LEAVE

Date of Request

, request leave from my duties with the

The purpose of this leave is

Sick Leave or Personal Leave

Vacation Leave

Comp Time

All employees shall submit their request for vacation a minimum of ten (10) calendar days prior to the anticipatedeffective date of such vacation. (City Policy Section 2-28 (d)(5))

I understand that all sick leave is to be concurrently charged towards FMLA leave. All other leave will be charged toFMLA, if eligible.

Employee's Signature Date

I recommend this request be

LeaveSupervisor Signature Date

Department Head or City Manager

Start date of Leave:

inclusive, a period of

I

End date of Leave:

hours.

Approved Disapproved

pay.with without

Approved Disapproved

, Employee #:

City of Eagle Pass from Annniversary year of:

Select appropriate section to charge your leave:

Reason for disapproval: