REQUEST FOR VACATION SICK DAYS OR RUNNING LATE FORM

(If you are employed at DPW, Please use DPW Form link below to go to that form)

DPW Form

FIRST & LAST NAME*

Type of Leave Requesting*

Vacation Sick Personal Day

Running Late Other (Jury Duty etc. explain below)

If you checked Other as a choice please explain:

If Running Late Please give the reason & How long you anticipate to be late to work

Dates Requested for Vacation Leave

Dates Requested for Sick Leave

Date Requested for Personal Day/s

Approval is granted based on the assumption that an employee still has the requested time available. Approval may be withdrawn if sufficient coverage is not available within a department.

*You must submit a separate form for each category of Vacation Requests, Personal Days or Sick Day Requests*