Monthly Leave Accrual Forms 2

University of Alabama at Birmingham School of Optometry

Monthly Leave Form July-07 Name:____________________________________ Month/year: ______________________ Vision Sciences Department:______________________

Vacation Total days taken:______________________________________________________________ Date(s): _____________________________________________________________________

Sick Total days taken: ______________________________________________________________ Date(s):______________________________________________________________________

Personal Holiday (three per year, July 1 through June 30) Total days taken :______________________________________________________________ Date(s):______________________________________________________________________ Bereavement for the members of immediate families: husband, wife, children (including stepchildren), brothers or sisters (including stepbrothers or stepsisters), brothers-in-law, sisters-in-law, parents (including stepparents), grandparents, grandchildren, father-in-law, mother-in-law, sons-in-law, or daughters-in-law. Up to three days’ leave with pay. Date(s):______________________________________________________________________

Official Leave for days away from work location on business related to departmental or professional activities. All faculty and staff are to notify their respective department chair or supervisor when planning to be away on official business. Date(s): _____________________________________________________________________ Purpose of trip and destination:___________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ _____________________________________ Employee signature

__________________________________ Department authority

In order for leave accrual to be recorded, this form must be returned. If no days were taken during the month, record 0 (zero) days taken. Please complete this form, including your supervisor’s signature as department authority, and return it by the 10th of the month to Linda Phillips, WORB 636, zip 4390.