EASTERN KENTUCKY UNIVERSITY
SICK/VACATION REQUEST
(Faculty and Professional Staff Form)
Printed Name (Last, First)
EKU ID#
Campus Phone
Requesting:
S-Sick
V-Vacation
Bre-Bereavement Leave
FLH-Floating Holiday
W-Wellness Holiday
FML-FMLA
Leave Code
FROM:
ex. 1/09/00
TIME:
ex. 8:00 AM
TO:
ex. 1/14/00
TIME:
ex. 4:30 PM
TOTAL:
ex. 37.50 Hours
Total Sick Requested:
Total Vacation Requested:
Total Bereavement Requested:
Total Floating Holiday Requested:
IMPORTANT: Leave request forms must be turned into Human Resources as near to the date taken and preferable within the pay period that they occured.
Employee Signature
Date Signed
Supervisor Signature
Date Signed
Dean (If required)
Date Signed
Vice President (If required)
Date Signed
Return completed form to Payroll, Coates Box 3A
System Processed Date
HR Employee Initials/Date
Comments
ch 3/23/01