DARTON COLLEGE

LEAVE REQUEST

 

 

 

_______________________________                      ______________________________

               Employee Name                                                   Social Security Number

 

 

Period of Absence:            Beginning ________________    Ending  _________________

 

Reason for this absence:            ________________________________________________

 

                                                ________________________________________________

 

                                                ________________________________________________

                                               

                                                ________________________________________________

 

During this absence, my teaching or other duties will be taught or covered as indicated.

 

Day                 Class               Room              Hour                To be taught or covered by

 

 

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

(Continue on back of this sheet, if necessary)

 

 

                                                                                    Approval:

 

 

 

 

_______________________________                      ______________________________

Employee Signature               Date                             Division/Department Head       Date