Application for Leave

You can use the paper form or this web site, do not do both.  The leave and travel request forms are combined for convenience.  Prior approval of all travel is required.

Designation:  Family and Medical Leave Work Related Injury / Illness Neither Vacation Vaction in place of sick leave Sick Leave Compensatory Time Jury Duty / Court Appearance Military Leave* Professional Society Meeting University Business Consulting Other (specify in additional information box) UNPAID time off < 10 days UNPAID leave of absence > 10 days UNPAID extension of leave of absence
From: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010
To:      January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010   Total Hours of leave :  [assume each day is 8 hours].  OSU holidays   /  If sick leave is selected above please specify  Illness/injury  Medical appointment  Death in family  Exposure to contagious disease / If UNPAID leave is selected above please check:  Medical  Personal.

Approvals

Approval of this request is contingent on the availability of leave balances.  Falsification of this Application for Leave or of the supporting documentation is grounds for disciplinary action up to and including dismissal.  Employee Signature indicated electronically.  Please enter your OSU email address where your confirmation will be sent.

Department Signature.  You will receive an email confirmation from Denise Smith or his designee that is the department signature.  College Signature.  We will take care of college approvals, you don't need to worry about that.  Staff absence requires only the above two signatures.  Faculty member absences exceeding ten consecutive days require approval by the provost per faculty rule 3335-5-08.  Provost Signature if needed will be on the standard paper form.

Optional Information

Person responsible in my absence  Phone # 614-  In an emergency, I may be reached at Phone #  or by E-mail

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