UNCG Housing and Residence Life | Office Use Only | Forms | Leave Request Form

Leave Request Form

HRL Maintenance Leave Request Form

Name(Required)

Email(Required)

Leave Requested(Required)

Beginning Date(Required)

Begining Time(Required)

End Date(Required)

End Time(Required)

Total Hours Requested Off(Required)

Comments

Reason for Sick(Required)

Illness which incapacitated me for duty**

Medial Appointment

Death in the family

**Medical Certificate (when required)

Relation to Departed(Required)

(in the event of death in the immediate family, a maximum of 3 days can be charged to sick leave)