AUTHORIZED LEAVE REQUEST FORM

CITY OF ST. CATHARINES

Employee Name:	Employee #:

# Days/Hours	From (year/month/day)	To (year/month/day)	Code	Approval (initials)
days hrs
days hrs	Choose an item.
days hrs	Choose an item.
days hrs	Choose an item.
days hrs	Choose an item.
days hrs	Choose an item.
Employee Comments:

Request for deferred vacation: ________ days(s) deferred until ________________

Employee Signature:	Date:

________________________________________________________________________________________________

Supervisor Comments: