NATIONAL CENTER ON DEAFNESS
8/12 Interpreter        Hourly
Service Provider Leave Form
 
ALL LEAVE MUST BE REQUESTED AT LEAST 2 WEEKS IN ADVANCE, UNLESS IT IS AN EMERGENCY.
THIS REQUEST IS CONTINGENT UPON SUPERVISOR’S APPROVAL.
YOU WILL BE NOTIFIED WITHIN 3 WORKING DAYS IF YOUR REQUEST WAS NOT APPROVED.
TO PRINT THIS FORM: CHOOSE "FILE / PRINT SETUP / SET THE TOP AND BOTTOM MARGINS TO "0.01" / PRINT THE FORM (ONE PAGE).
NAME:
 TODAY'S DATE
  
TYPE OF LEAVE:
SICK        OTHER
PLEASE EXPLAIN: ( IE: FAMILY ILL, PERSONAL HOLIDAY, BEREAVEMENT, ETC )
ADMINISTRATIVE LEAVE ( REQUIRES DIRECTOR'S SIGNATURE )
________________________________
ROZ ROSEN, DIRECTOR
DATE(S) OF LEAVE
SUB NEEDED?
(IF YES, LIST CLASSES)
CLASS TIME
TOTAL HOURS
TOTAL NUMBER OF HOURS REQUESTING LEAVE:   



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SIGNATURE OF EMPLOYEE

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IMMEDIATE SUPERVISOR

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NCOD ADMINISTRATOR