Government Officer Annual Leave of Absence Form
Submit your annual leave request using the Government Officer Annual Leave of Absence Form. Please complete all sections accurately to ensure timely processing.
Full Name
*
First Name
Last Name
Official Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department
*
Please Select
Finance
Human Resources
Public Works
Education
Health Services
Transportation
Other
Position/Title
*
Leave Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Leave End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Total Number of Leave Days Requested
*
Reason for Leave
*
Please Select
Vacation
Family Commitment
Personal Reasons
Medical (non-sensitive)
Other
Replacement/Coverage Officer (Name and Contact)
*
Submit Leave Request
Should be Empty: