Office Use
Year(s):
Pending:
(Deadline for application to be received in Approved:
(Date) Application Received Date: ________________ Denied:
Letters:
APPLICATION FOR VACATION LEAVE
EMPLOYEE
(Read reverse side for requirements)
Section 1 – General Information
Name ____________________________________________ Personnel No. ____________________________
(Last) (First)
Home Address _____________________________________ Home Phone _____________________________
__________________________________________________ Work Phone
_____________________________
(State) (Zipcode)
Present Job Position/ Worksite _________________________ Years of Work Experience
__________________
Degree Achieved ___________________________________________________________________________
Section II – REASON FOR VACATION LEAVE
The employee must undertake an activity that will be beneficial to him/herself, and Electronica Company.
Applicants must be pre-approved for the leave.
Please indicate your reason for Vacation Leave below and submit an explanation to support your request.
1. Personal reason
2. Time-off for vacation
3. Personal illness (in lieu of sick leave)
4. Other: ______________________
I am requesting a professional sabbatical leave commencing ___________ until ___________.
Employee's Signature Date
By signing this recommendation, I am verifying that while under my supervision, this employee has received
satisfactory evaluations and is not being considered for documentation.
[Title] Signature Date