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Arch Ford ESC Leave Request DATE OF LEAVE:

# OF DAYS:

PAY CODE: 110 111 112 113

Sick Day

200

Personal Day

300

Vacation

400

Death of_____________________________ (state relationship)

405

Jury Duty

410

School Sponsored Student Activity Day

415

Professional Day

420

Military

Employee's Signature:_______________________________________ Date: ______________ Supervisor Signature: ________________________________________Date:______________ Supervisor: Approve_______ Disapprove_______

HUMAN RESOURCES DATE ENTERED:________________________ Entered By:___________ SUFFICIENT LEAVE? YES_______ NO_______

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