ulaw-less5days.doc - The Department of Mental Health and...

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The Department of Mental Health and Addiction Services REQUEST FOR UNPAID LEAVE LESS THAN FIVE (5) DAYS NOT COVERED BY State/Federal FMLA This form is to be completed in advance of your unpaid leave of absence. This form must be completed and returned to your Facility Human Resource Director for review and approval/denial. Failure to request unpaid leave in advance but still taking the time off shall result in your time being charged to Unauthorized Leave of Absence. This form is not to be used in conjunction with FMLA. Employee Name: ______________________________ Date: ________ Job class: _________________________________________________________ Facility ___________________________ Unit/Division: ___________ Request for use of: __ Unpaid Leave of Absence (LAW) __ Unpaid Sick Not FMLA)
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  • Summer '14
  • JohnWeekes
  • Business Law, FMLA, Leave of absence, Leave, unpaid leave, Facility HR Director

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