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2. PARKS & RECREATION DEPARTMENT

   Request for Use of Sick Leave

   PART-TIME / SEASONAL / TEMPORARY

4. This form must be completed by any staff member who wishes to use sick leave benefits. Request to use allotted sick time must be submitted before time is taken, or on the day when the employee returns to work.  Employees will receive this original request indicating approval of the request, do not assume that submission of a request signifies approval.  Please allow ample time to process your request. 

6. First Name*
7. Last Name*
8. Choose your Division*
   -- Select One --Community Services DivisionRecreation DivisionAquatics DivisionSenior Division
10. Employee would like to use Sick Time if Available:*

    1. Yes, use my sick time.
    2. No, I choose leave without pay.
11. Name of Employee Substituting for you:
13. REQUEST START DAY OFF:*
    REQUEST START DAY OFF:

    REQUEST START DAY OFF:
14. REQUEST LAST DAY OFF:*
    REQUEST LAST DAY OFF:

    REQUEST LAST DAY OFF:
18. Approval of Leave (DO NOT CLICK)

    1. YES
    2. No
19. TYPE SUPERVISOR'S NAME:*
20. SUPERVISOR'S TITLE:*
    -- Select One --COORDINATORSUPERVISOR
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field