Get the free Leave Without Pay Request Form - Algonquin College
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Leave Without Pay Request Form
Employee# ___
Employee Name: ___
Supervisor: ___ Department:
___
Start Date: ___
Finish Date:
___
(dd/mm/yy)
(dd/mm/yy)
(Up to a maximum of 12 months may be requested.)
Reason For Request:
___
___
___
___
___
Employee’s Signature: ___
Date: ___
(dd/mm/yy)
Please action the Leave Without Pay Request for the employee noted above:
___
(Manager/Chair’s Signature)
___
(dd/mm/yy)
Manager’s Signature required for leaves up to...
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