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Leave Request
(Requiring ERSC Authorization)

To be completed when an employee is requesting leave of 5 days or more, except annual or personal.

INSTRUCTIONS: Please complete form, discuss leave plans with immediate supervisor, obtain signatures, attach proper documentation, and forward to ERSC. You must submit page 2 with appropriate signatures. Keep a copy for your records. Refer to reverse side for detailed instructions. Understanding of leave policies is your responsibility. Going on leave may impact your benefits and costs, sometimes significantly. Make sure you understand the potential impact by reading this form thoroughly and reviewing the Employee Benefit Summary for leave rates. Bereavement leave requests in excess of the contract allowance should be submitted on this form.

Name
PDF Size
Form Number
Leave Request
(Requiring ERSC Authorization)
143 K 430-1

Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat

 

For questions regarding forms, call Harriet Potosky at (301) 279-3538.

Updated December 27, 2012 | Maintained by Missy Gumula
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