Comments: (No Medical/Diagnostic Comments). Please Limit Comments to the Text Area Provided.
Attach any documentation required for approval
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Select Employment Category: |
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Begin Date: |
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Last Day Worked: |
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Actual Return Date: |
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Employee ID: Org Unit: |
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| Last Name: | Type of Leave of Absence: | |||
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Approval Signatures: |
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Initiated By: |
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Director/Chair: |
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Dean/VP: |
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Human Resources: |
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Please Return All Copies of Completed Form to Human Resources |
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Payroll / Personnel Action Request (PAR)
Leave of Absence
Staff / Faculty / Other - Non Employee