ࡱ> S^R5@ *Ibjbj22 "^XX0z """""""6z z z 8 dc!,6 x NNNN/< LNNNNNNRNu"| "/||N""NN|"N"NL|LJ""N! \z D0 q&Rq66""""q"0^L?=NN66Dz x66z WYTHEVILLE COMMUNITY COLLEGE 1000 East Main Street % Wytheville, VA 24382 APPLICATION FOR LEAVE OF ABSENCE Number of hours leave requested: __ FORMTEXT      ___________________________________________________ (leave must be reported in hours and tenths of an hour-- See Note #1 on reverse side; Nine-month faculty see note below*.) Beginning Ending Date/Time__ FORMTEXT      _______ Date/Time____ FORMTEXT      _______ M/d/yyyy h:mm am/pm M/d/yyyy h:mm am/pm Check the type of leave requested: (see reverse side for explanation of the types of leave) ___ FORMCHECKBOX _____Administrative Leave Reason:  FORMTEXT       ___ FORMCHECKBOX _____Annual Leave ___ FORMCHECKBOX _____Bone Marrow and Organ Donor ___ FORMCHECKBOX _____Community Service Leave ___ FORMCHECKBOX _____Compensatory Leave ___ FORMCHECKBOX _____Family & Medical Leave spouse; ___ FORMCHECKBOX _____parent; ___ FORMCHECKBOX _____child(18 and under) ___ FORMCHECKBOX _____Family & Personal Leave (Virginia Sickness and Disability Program) ___ FORMCHECKBOX _____Family Sick Leave spouse; _ FORMCHECKBOX _ child; _ FORMCHECKBOX _ parent; _ FORMCHECKBOX _ sibling; _ FORMCHECKBOX _ other relative living in household ___ FORMCHECKBOX _____Leave without Pay Reason:  FORMTEXT       (use additional sheet if more space is needed) ___ FORMCHECKBOX _____Military Leave (attach documentation) ___ FORMCHECKBOX _____Overtime Leave ___ FORMCHECKBOX _____Personal Leave* (9 month faculty) ___ FORMCHECKBOX _____Sabbatical Leave ___ FORMCHECKBOX _____Sick Leave* ___ FORMCHECKBOX _____Workmen s Compensation Leave ___ FORMCHECKBOX _____ Other (explain)  FORMTEXT        FILLIN "You must enter your full name or your application will be rejected" \d "Must enter name here, right-click to update" \* MERGEFORMAT Must enter name here, right-click to update __ FORMTEXT      ____ ________________________________________ Employee s Name and Signature Date Supervisor s Signature INSTRUCTIONS All salaried employees will use this form in making application for leave of absence. Application for leave of absence form should be sent immediately to the Human Resources Office by the supervisor. A Physicians certificate may be required with application for sick leave. Applications for leave without pay must be fully explained and approved by the President. (Attach Documentation) *Nine-month faculty must use personal and sick leave in half-day increments. NOTE #1 - Hour divided into tenths 0 minutes 2 mins. 59 secs Disregard 3 minutes 8 mins. 59 secs. .1 hour 9 minutes 14 mins. 59 secs .2 hour 15 minutes 20 mins. 59 secs .3 hour 21 minutes 26 mins. 59 secs .4 hour 27 minutes 32 mins. 59 secs .5 hour 33 minutes 38 mins. 59 secs .6 hour 39 minutes 44 mins. 59 secs .7 hour 45 minutes 50 mins. 59 secs .8 hour 51 minutes 56 mins. 59 secs .9 hour 57 minutes 60 mins. 1.0 hour A - -Annual Leave Annual leave is intended for vacation and other personal purposes. (Refer to DHRM Policy 4.10) AL - - Administrative Leave Administrative leave may be used when a) serving on a jury; b) being under subpoena as a witness; c) interviewing for a state job; or d) taking a test for state employment. (Refer to DHRM Policy 4.05) NOTE: If reason a or b is used, the employee must turn over any jury or witness fees, except for mileage fee, to the Commonwealth of Virginia. If the employee elects to keep these fees, then administrative leave cannot be used and the absence will be charged to his/her annual, personal, or compensatory leave balance if the balances are sufficient to cover the absence. BMOD Bone Marrow and Organ Donor Eligible Employees may use upto 30 workdays of paid leave in any ca;lendar year, in addition to other paid leave, to donate bonemarrow or other organs. (Refer to DHRM Policy 4.37) CS - -Community Service Leave Full-time employees may take up to sixteen (16) hours of leave per calendar year to perform service within their communities. Such service may be provided through school assistance or as a Volunteer member of a community organization. (Refer to DHRM policy 4.40) FML - - Family and Medical Leave Allows eligible employees who have been employed with the Commonwealth for at least 12 months and for at least 1,250 hours during the 12-month period preceding commencement of the leave, to take up to 12 weeks of paid/unpaid leave following the birth or adoption, or placement of a child with them for foster care, or for their serious personal illness, or for the illnesses of their spouse, parents, or children (18 and under). (Refer to DHRM Policy 4.20) FPL - -Family & Personal Leave (VA Sickness & Disability Program) This leave may be used for absences due to family and personal reasons as well as for personal illnesses or injuries. (Refer to DHRM Policy 4.57) FS - -Family Sick Leave Family sick leave may only be used for illness, injury or death of parents, spouse, child, sibling or any relative (blood or by marriage) who resides in the employees household. M - -Military Leave Dpr " $ & ( < > @ J L   Ҿ{o[{E{7h>:5>*CJOJQJh+jha4D5>*OJQJUhmHnHu&jh>:5>*OJQJUhh>:5>*OJQJh jh>:5>*OJQJUhh>:OJQJhh>:5OJQJhh>:CJOJQJhh>:5CJOJQJh h>:CJh>:h>:B* OJQJ^JaJph"4h>:B* OJQJ^Jph"4"h>:5B* CJOJQJ^Jph"4jh>:UmHnHu ( l  v  r !^` ^` x ` 8x` $` 2 ` !`h$d&d P#`a$ 1II\ $   . 6 8 L N P Z \ j n  v ”Չs”dWdWh>:CJOJQJaJhh>:CJOJQJ^JaJh*jh>:5>*CJOJQJUhh>:CJOJQJh/jha4D5>*CJOJQJUhmHnHu*jh>:5>*CJOJQJUh$jh>:5>*CJOJQJUhh>:CJOJQJhh>:h>:5CJOJQJhh>:5>*CJOJQJhv | ~     2 4 6 @ Z ` b ~ 񺩜qX0jha4Dha4D5>*CJOJQJUh,jha4D>*CJOJQJUhmHnHu'j$h>:>*CJOJQJUhh>:>*CJOJQJh!jh>:>*CJOJQJUhh>:CJOJQJh0jha4Dha4D5>*CJOJQJUh$jh>:5>*CJOJQJUhh>:5>*CJOJQJh Z A$:Z ^` !^` ^` ^` ^` ^`~ '().ADESTUZyz}~ƻƢƻƉƻpƻch>:>*CJOJQJh0jpha4Dha4D5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUhh>:CJOJQJhh>:5>*CJOJQJh$jh>:5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUh$'(678=WXYZhɼԮɮԮ|ԮɮԮcԮɼԮ0j@ha4Dha4D5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUh0jXha4Dha4D5>*CJOJQJUhh>:5>*CJOJQJhh>:>*CJOJQJhh>:CJOJQJh$jh>:5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUhhijtu.0ԻԻԻpɻԻWԻF!jh>:>*CJOJQJUh0j ha4Dha4D5>*CJOJQJUh0j ha4Dha4D5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUh0j(ha4Dha4D5>*CJOJQJUhh>:5>*CJOJQJhh>:CJOJQJh$jh>:5>*CJOJQJUh0jha4Dha4D5>*CJOJQJUh0DFHRTV:@B^`blη󬞋rY0j ha4Dha4D5>*CJOJQJUh0jv ha4Dha4D5>*CJOJQJUh$jh>:5>*CJOJQJUhh>:5>*CJOJQJhh>:CJOJQJh,jha4D>*CJOJQJUhmHnHu!jh>:>*CJOJQJUh'j h>:>*CJOJQJUhh>:>*CJOJQJh  (*,6Z`b~68:DfƻƢƻƉƻpƻWƻ0j. ha4Dha4D5>*CJOJQJUh0j ha4Dha4D5>*CJOJQJUh0jF ha4Dha4D5>*CJOJQJUh0j ha4Dha4D5>*CJOJQJUhh>:CJOJQJhh>:5>*CJOJQJh$jh>:5>*CJOJQJUh0j^ ha4Dha4D5>*CJOJQJUh fh|~ (*,᫒}}p]O9]*j h>:5>*CJOJQJUhh>:5>*CJOJQJh$jh>:5>*CJOJQJUhh>:5CJOJQJh(h>:5>*B* CJOJQJ\aJph"41jh>:5>*B* CJOJQJU\aJph"4h>:CJOJQJh,jha4D>*CJOJQJUhmHnHu'j h>:>*CJOJQJUhh>:>*CJOJQJh!jh>:>*CJOJQJUh,68_`gi  zoboWNENEhcQOJQJhhNOJQJhhcQ5OJQJhh>:5CJOJQJhh>:5OJQJhh>:CJOJQJaJhh>:5CJOJQJaJhh>:5>*CJOJQJaJhh>:h>:CJOJQJhh>:OJQJY(hh>:OJQJhh>:CJOJQJh$jh>:5>*CJOJQJUh/jha4D5>*CJOJQJUhmHnHui&@$  P` @ xx$d%d&d'dNOPQ]` ^@ `a$gd~u ` )ux^ u^` ^` 012;<MVW_p{|6=NYZb (e<ABZagi. J K Q R !!!$!%!7!!!̿件̿̿̿̿ h>:5h>:h>:5CJOJQJhh>:5CJOJQJhh>:CJOJQJhh>:OJQJhhcQOJQJhhNOJQJhH e<aK !!ExFbH1I2I3I>I$a$ 0^`0 0^`0 `9 ,dPB` @ $d%d&d'dNOPQ]` ^@ `gdcQ!!!DDDEEEEEEvFwFxFF`HaHbHfHgHH1I3I5I=I>I?IIIII\ٝh]~ha4D h>:5<ha4DCJ aJ h>:CJ aJ h>:5h>:h>:OJQJhh>:CJOJQJhh>:CJOJQJhUh>:5CJOJQJhh>:5CJOJQJh Employees are entitled to maximum of 15 days of paid military leave for each tour of active duty. Specifically, an employee is eligible for leave with pay for up to 15 workdays in a federal fiscal year (October 1 through September 30) for military duty, including military training, if he/she is a former member of the armed services, or is a member of any reserve component of the Armed Forces or the National Guard. (Refer to DHRM Policy 4.50) PL - -Personal Leave (9 month faculty) This leave may be taken at the discretion of the faculty member with supervisors approval. This leave is not intended for recreational purposes. Sabbatical Leave A compensated leave of absence of one or two semesters for full-time academic faculty and up to 12 months for administrative and professional faculty and the college president. The objective of sabbatical leave is to provide activities, which will improve teaching effectiveness, enhance creative and/or artistic activities, improve professional competency, and provide a renewed capacity for significant contribution of service to the college and the community at large. W - -Workmens Compensation Leave A salaried employee incapacitated by injury or illness as defined by the Workmens Compensation Act is entitled to benefits provided in Sec. 4.60 of the DHRM Policy Manual. SS09262003 Use to move between fields. Check Status Area at the bottom of screen for tips about form fields >I?IIIIIII\ 0^`0$ !`a$5 0 00&PP/ =!@"@#@$@%nb`XPNG  IHDRasRGBgAMA a cHRMz&u0`:pQ< pHYsiTS6PLTE+++999HHHVVVrrrddd IDATxrH `ewkvXilI-LGeC઱DgEtYDg^5\ԉyulNtDDܜՉ<:ї<:=:ї<:gV'Rs'V'rD_nNt@D_aNt@D_cT/Bty%uX_RY=:ך˕p Ge":yQ'zsS'c]@ M*D4ϥNtsH[WYUDG\D2O ѵ:]<:͉NtAϢN;܉^N"hf<ܷ76룇0':y,QCGcI6z$sR!} I(|s Án| #}"NSU.K}Cl#]3kit]>Qw@wH|=>|;e0'%ϭTҟ/-yOn-K,[1WOnknɆ橲Y.-L)Ƿ.!ɭrtD>4ˆ~v+k:]@W\zG_iBSX芮~vmc~+0٭npz+nŏ5ÃKog7s靛SH27}:7cM4n&M(o. ~6i#@smu=Y#h:FAČi"m/h>w*fa95?,ݠG3SoA?l4Бzan~_}я1[R|$QK4SNsC³]R|o:5_Ns *ތzr GSh ݣ)κME0\_uDw93N0i(KS'Cy$՗7NtE'ͭi2):cDɍ-ço8~qiJ=R Nh|QM^,in ЏZ3:5Owwet,>4_]Mh'6~Ģ+i~U/:4Od5{ͫkau߬ ToC̏_oϕ`<5D_F/L/HIENDB`D Hours0.0)Enter number of hours & fraction of hoursD BegDateTimeM/d/yyyy h:mm am/pm&Enter date/time as M/d/yyyy h:mm am/pmD EndDateTimeM/d/yyyy h:mm am/pm&Enter date/time as M/d/yyyy h:mm am/pmtDeCheck1|D ReasonAdmtDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1~D ReasonLYOPtDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1tDeCheck1~D ReasonLYOPDText1M/d/yyyyM/d/yyL@L Normal`OJQJ_HmH sH tH z@z Heading 13$$ )u@&^`a$5CJOJQJhtH ub@b Heading 2$ @&`5CJOJQJhtH ub@b Heading 3$ @&`5CJOJQJhtH uDAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List N%@N Envelope Return`OJQJh$@h Envelope Address-@ &+D/^@ `R>@R Title$`a$5CJOJQJhtH urC@"r Body Text Indent! ^`CJOJQJhtH uXJ@2X Subtitle$h`a$5CJOJQJhtH uXB@BX Body Text `CJOJQJhtH u4@R4 Header  !4 @b4 Footer  !LOpWh;iA$]-Si&  e<aKwa012=>00000(00000000000000000000 0 0 00 000 0 00 0p0000000000000p@0My00&@0My00&@0My00&@0My000x-%wy|s>Nr~(DT}'7Yit#)`p0@VfXFFFG$FtG$G$G$G$G$G$G$G$G$G$G$G$G$G$FtG$G$G$G$G$G$G$Ft'Fl,b$b`X7L@B(    c dA. WCC-LogouR`TuR`T#" `B S  ?-ttHours BegDateTime EndDateTimeCheck1 ReasonAdm ReasonLYOPText1t?sO* W!WW,WW\WWtWW̯""::FIg g w 77DHNNs   >*urn:schemas-microsoft-com:office:smarttags PostalCode9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCity:*urn:schemas-microsoft-com:office:smarttagsStreet; *urn:schemas-microsoft-com:office:smarttagsaddress=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsplace  sMNr'(ST67hi*op?@ef  / 0 2 ; M V W _ p { |     ) 3 6 = N Y Z b s }  ./002<VM h i ! " F G k l   033333333333333333333h; l 02<0Shivaji SamantaShivajiShivaji SamantaShivaji SamantaShivaji SamantaShivaji SamantaShivaji SamantaShivaji SamantaShivaji SamantaShivaji Samanta>:a4DcQN~uI,!h; 0a0@pPP P P@PPPP,@P@UnknownGz Times New Roman5Symbol3& z ArialA& Arial Narrow5& zaTahomaIFMonotype Corsiva"1hyyyn -n -#24d$$ 3QH(?NWYTHEVILLE COMMUNITY COLLEGEShivaji SamantaShivaji SamantaL@L Normal$CJ OJPJQJ_HaJ mH sH tH DAD DeOh+'0 4@ \ h t WYTHEVILLE COMMUNITY COLLEGEYTHShivaji SamantahivhivWCC Leave.dotaShivaji Samanta5ivMicrosoft Word 10.0@ @@eW@ۜ\n՜.+,0  hp  Wytheville Community CollegeY- $A WYTHEVILLE COMMUNITY COLLEGE Title  !"#$%&'()U+,-./013456789:;<=>?@A[CDEFGHIKLMNOPQTVWXYZ\]Root Entry F\_Data *1Table2%WordDocument"^SummaryInformation(BDocumentSummaryInformation8JCompObjj5@ Z\bjbj22 "^XXqBqB    dc!, "x!!!!!!!!!!!!!!!#R%! !!!!!! !!!!!!! ! !!!!!!!! !!! \ !!!!0"!%!%! % !!!!!!!!!!! $ !  1h/ =!"#$%fault Paragraph FontViV  Table Normal :V 44 la (k(No List ^M904 v ~ h0f,!\! >I\ %\]~@P@UnknownGz Times New Roman5Symbol3& z ArialA& Arial Narrow5& zaTahomaIFMonotype Corsiva"0h0@?]~  FMicrosoft Word Document MSWordDocWord.Document.89q