LEAVE REQUEST FORM

Employee Date:

COCC ID #

Department

Dates/Hours Requested

Type of Leave:

REMINDER:  EMPLOYEES MUST BE ON STAFF FOR 6 MONTHS BEFORE TAKING VACATION.  If "vacation" time is requested within the first 6 months, it must be applied as Leave Without Pay.

Employee Signature_________________________________________________Date___________                 

Supervisor’s Signature________________________________________________Date___________

INSTRUCTIONS:
1.All leave requests must be APPROVED before the leave is taken.
2.The employee and Supervisor each keep a COPY of the approved request.
3.The SUPERVISOR SENDS the approved leave form to Fiscal Services.
4.If the approved time is not taken, it is the employee’s responsibility to submit a revised leave request form
   to the Supervisor for signature and forwarding to Fiscal Services.
5.Classified staff must report approved leave on monthly time sheets.
(Rev 2/99)

Sign and send to: Central Oregon Community College 2600 NW College Way Bend, Oregon 97701-5998

Phone:  (541) 383-7216 Fax No: (541) 383-7505 TDD No:  (541) 383-7708