Form 1 - Application for L
eave of Absence
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| indicates that the form filling function is available for Adobe/Acrobat Version 3.0 or higher.
Click on one of the following versions of the Form 1 - University of
Application for Leave of Absence.
ITEM 02. Start with the first three letters of last name in each box.
ITEM 05. Enter dates in six digits - example: January 5, 1993 thru January 12, 1993 From 01/05/93 thru 01/12/93
ITEM 06. Use this item only when submitting a correction to a document previously processed.
ITEM 07. Enter hours taken to two (2) decimal places Example: (a) 16 hrs should be written 16.00 (b) 24 ½ hours should be written 24.50
Note 1: A licensed physician's certificate must be attached for absences of five or more consecutive working days.
Note 2: Indicate relationship of deceased.
Note 3: Other - temporary cessation of normal operation: extended vacation, personal reason, etc.
3 copies per page
||This version utilizes Adobe/Acrobat Version 3 or higher
form filling capability that allows the leave information to be entered via the computer. Three
copies of the same information are printed on one sheet of paper. This version may be used in
cases where triplicate copies are necessary.
| Blank Non Form Fillable
3 copies per page
||This version utilizes Adobe/Acrobat to simply print out copies of the Form 1
to be manually completed. Any version of Adobe/Acrobat will allow you to print this document.
The printed sheet may be cut to provide blank copies of the Form 1.
The Document Number on the Form 1 is not preprinted and must
be manually entered by the employee. You may use the format indicated below to derive a unique document number
for an employee throughout a calendar year.
Document Number Format:
digits 1 and 2 - Requestor Month (box 9)
digits 3 and 4 - Requestor Day (box 9)
digits 5 and 6 - Leave Code (box 3)
Example: The Requestor Date (box 9) is 09/15/98 (month=09 and
day =15) and the Leave Code is 02 (box 3). Using the above format, the document number
that must be entered in box 0 is 091502.
The Document Number must be unique for all Forms 1 submitted on the
same day with the same leave code. Therefore, multiple requests must not have the same Requestor Date (box 9).
The format above using the requestor month, day and leave code is NOT mandatory but may be used to
derive a unique document number. Any other algorithm may be used (eg., sequential starting from 000001, etc.) the only criteria being that the document
number must be unique for an employee for the calendar year.
Please report any problems, questions or comments regarding the printing and use
of the Form 1 to Steve Yamada via e-mail at email@example.com.