Leave Request for Hourly Employees | Leave & Holidays | Benefits | Human Capital Services

PERSONAL INFORMATIONName:
E-mail Address:

DATES/HOURS OF LEAVE—Recorded in 15 minute incrementsFrom Date:
From Time:
To Date:
To Time:
Total Hours Requested

LEAVE TYPE

Choose Just ONE

Vacation Leave VAC
Hours and dates

Sick Leave SCK
Hours and dates

Parental Leave PLV
Hours and dates

Funeral Leave FNL
Hours and dates

Jury Duty JRY
Hours and dates

Military Leave MIL
Hours and dates

Leave Without Pay
Hours and dates

Discretionary Day DDY Date

Compensatory Time CMT
Hours and dates

Holiday Compensatory Time HCT
Hours and dates

Other Absence
Type, Hours and dates

REASONReason for Leave or Other Absence (Optional):

SUPERVISORSupervisor's E-Mail Address (Required for submission)

Department TIMEKEEPERTimekeeper's E-Mail Address (optional)

This form may not work on all devices.

Signatures only required if printing request instead of submitting online.

Employee's Signature
  Date
Supervisor's Signature
  Date

*Other Leave--Disaster Leave-DIS, Donor Leave-DON, etc.

See instructions for questions about completing this form.

Is this Family Medical Leave Act related? If yes, refer to the FMLA information under Leave Programs

Kansas State University