Leave Request for Hourly (Non-Exempt) Employees

If you see this don't fill out this input box.

Name*

E-Mail Address*

From Date and Time:*

To Date and Time:*

Total Hours Requested*

Leave Type(s):*

Vacation Leave - VACSick Leave - SCKFuneral Leave - FNLJury Duty - JRYMilitary Leave - MILLeave Without PayDiscretionary Day - DDYCompensatory Time - CMTHoliday Compensatory Time - HCTOther Absence*

Select one or more types of leave

Reason for Leave or Other Absence (Optional):

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

Supervisor's E-Mail Address (Required for submission)*

Department Timekeeper's E-Mail Address (optional)

Submit Leave Request to Your Supervisor for Approval 

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

Signatures are only required if leave request is printed instead of being submitted online.

Employee's Signature:


Date:

Supervisor's Signature:


Date:

Related Information

• Leave Programs
• KSU Policy and Procedures Manual Chapter:
  • Employee Leaves, Holidays, and Other Absences for Employees of Kansas State University, 4860