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By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
EMPLOYEE LEAVE REQUEST FORM
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Employee Information & Time Off Dates Requested
This section is complete
This section is incomplete
2.
Electronic Signature
This section is complete
This section is incomplete
3.
Request approval for leave and submit.
This section is complete
This section is incomplete
Employee Information & Time Off Dates Requested
STOP! This form DOES NOT REPLACE EMPLOYEE SELF SERVICE [ESS]
If you have access, please use ESS to enter all leave codes available. There are some codes as an option that require pre-approval from HR before using (codes listed with an asterick{*}. Please make sure you have that approval.
Any questions concerning the use of or issues with this form, please email
[email protected]
VERIFY and FORWARD
After you have completed the form: (1) Review and close the Employee Leave Request Form screen; (2) Open the email sent from
[email protected]
(Online Form Submission - Employee Leave Request Form); (3) Forward the email to your supervisor (for approval) and timekeeper (for time entry); (4) Your supervisor and/or timekeeper will notify you concerning your requested leave (approved or denied).
PLEASE NOTE:
If you selected the incorrect code, please reenter. This is only an electronic form and DOES NOT effect any leave until management approves it and the timekeeper enters your time.
EMPLOYEE NO.
*
First Name
*
Last Name
*
DIVISION
*
DEPARTMENT
*
SUPERVISOR
*
DATE REQUESTED FROM
*
DATE REQUESTED FROM
FROM DATE
DATE REQUESTED TO
*
DATE REQUESTED TO
TO DATE
REQUESTED HOURS
*
Enter number of hours requested.
LEAVE CODE
*
-- Select One --
220-CITY COMP EARNED (1.0)
221-STANDBY CITY COMP EARNED
225-FLSA-COMP(WILL POST AT 1.5X)
300-VACATION LEAVE
301-VACATION - PART TIME
310-SICK LEAVE
311-SICK LEAVE - PART TIME
320-COMP LEAVE
321-COMP LEAVE - PART TIME
325-MANAGEMENT LEAVE
330-PT W/BENEFITS HOLIDAY
350-VOLUNTEER LEAVE
352-PARENTS LEAVE
353-OTHER LEAVE CODE F
354-PARENTS LEAVE - PART TIME W/BENEFITS
355-FLOATING HOLIDAY
357-FLOATING HOLIDAY - PART TIME W/BENEFITS
358-VOLUNTEER LEAVE - PT
360-BANKED HOLIDAY
365-CIVIL LEAVE
370-ADMIN LEAVE PAID
371-SUSPENSION WITHOUT PAY
*375-MILITARY LEAVE PAID
*376-MILITARY LEAVE WITHOUT PAY
380-FUNERAL LEAVE
382-FUNERAL LEAVE - PART TIME
*388-FMLA-SICK LEAVE PT
*389-FMLA-MANAGEMENT LEAVE
398-LEAVE WITHOUT PAY
*390-FMLA-SICK LEAVE
*391-FMLA-VACATION
*392-FMLA-COMPENSATORY LEAVE
*393-FMLA-LEAVE W/O PAY
*394-FMLA-PAID TEMPORARY DISABILITY
*413-FMLA-WC
*420-FMLA-PD PARENTAL LV
449-COVID LEAVE
450-COVID LEAVE PT
Select LEAVE CODE from list
HR Approval Needed for Leave Types Flagged with Asterisk (*)
*HR approval is needed prior to submitting the leave types flagged with asterisk (*) If you have not received HR approval, do not submit this leave and contact HR at
[email protected]
to request approval. If the leave code selected does not have a balance available, you will be contacted by your Timekeeper to provide an updated leave code. Floating Holiday hours must be taken for a full day's hours. They cannot not be taken for partial hours.
COMMENTS
*
Enter any additional information (if any).
Continue
Electronic Signature
ELECTRONIC SIGNATURE AGREEMENT
By checking the "I agree" box below, you agree and acknowledge that 1) your REQUEST FOR LEAVE will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 4) LEAVE REQUEST MUST BE APPROVED BY MY SUPERVISOR OR UPPER MANAGEMENT PRIOR TO TAKING LEAVE TO AVOID POSSIBLE DISCIPLINARY ACTIONS.
I agree with the Electronic Signature Agreement
*
YES
NO
Digital Signature
*
Continue
|
Go Back
Request approval for leave and submit.
PLEASE NOTE:
Please follow the instructions below to request approval. All Leave has to be approved. Once approved your timekeeper will enter your time. This form DOES NOT replace Employee Self Service. If you have access, use ESS, unless you are requesting leave pre-approved by Human Resources
HOW TO SUBMIT, SAVE and PRINT
(1) Check the box beside 'Receive an email copy of this form'. Enter YOUR email address. (2) Select SUBMIT. (3) Answer Security questions/pictures. Select VERIFY. *A copy of this leave request will be emailed to you from Civicplus.
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
|
Go Back
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