Form Sf-6 - Application For Leave Form
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1APPLICATION FOR LEAVE
AGENCY
River Parishes Community College
SF-6 (R 12-04)
I request ___________
Employee Name
From: __________
AM
PM
To: __________
AM
PM
hours of leave.
/
/
/
/
Chargeable Leave Request
FMLA:
LWOP
Self
Annual
Straight Compensatory
Family
Sick
Time and One-Half Compensatory
Unpaid
Non-Chargeable Leave Request
EDUCATIONAL:
SPECIAL:
Funeral
Job Related
Act of God
Office Closure
MILITARY:
Jury Duty
Civil Air Patrol
American Red Cross
(max. 15 days per year)
Hazard Duty (law enf)
Active
Emergency Civilian
Voting
Other ____________________
Training
Physical
(Explain in “Comments” Section)
Comments
I CERTIFY THAT MY ABSENCE FROM DUTY WAS FOR THE REASON NOTED
Employee Signature
Date
Approved by and Title
Leave Definitions
Straight Compensatory:
overtime leave earned by
FMLA: (Family and Medical Leave Act) approved
Absence Leave Request:
employees exempt from federal Wage and Hour laws
absence available to eligible employees for up to 12
Annual: leave with pay granted an employee for the
when they have physically worked hours in excess of
weeks of leave per year for certain family and medical
purpose of rehabilitation, restoration and maintenance
their regular schedule.
reasons.
of work efficiency, or transaction of personal affairs.
Time and One-Half Compensatory: overtime leave
Self: for employee’s own serious health condition.
Sick: leave with pay granted an employee who is
earned by employees who are non-exempt under
suffering with a disability which prevents him from
federal Wage and Hour laws when they have physically
Family: an immediate family member (spouse, child or
performing his usual duties and responsibilities or who
worked hours in excess of their regular schedule.
parent) with a serious health condition.
requires medical, dental or optical consultation or
treatment.
LWOP: Leave Without Pay
Unpaid: when paid leave (annual/sick) is exhausted or
cannot be used under specific circumstances.
EDUCATIONAL
Civil Air Patrol: a member of Civil Air Patrol ordered to
Non Chargeable Leave Request:
Job Related: leave granted to attend a course that is
perform duty with troops or participate in field exercises or
Funeral: leave granted when attending the funeral or burial
relevant to job.
training. Leave shall not exceed 15 working days in any
rites of a parent, step-parent, child, step-child, brother, step-
one calendar year.
brother, sister, step-sister, spouse, mother-in-law, father-in-
MILITARY (maximum 15 days per year)
law, grand-parent or grand-child, provided such time off
Active: leave granted when called to active military duty.
Emergency Civilian: performing emergency civilian duty in
shall not exceed two days on any one occasion.
relation to national defense.
Training: annual training or active duty for training
Jury Duty: summoned to perform jury duty.
(weekend drills).
Office Closure: leave granted due to local conditions which
prevent the employee from attending work.
Hazard Duty (law enf): granted when an employee
Physical: leave granted to conduct mandatory physical to
engaged in law enforcement work is disabled while in the
enlist in military.
American Red Cross: leave granted for a period not to
performance of duty of a hazardous nature and because of
exceed 15 work days in any calendar year to participate in
such disability is unable to perform his usual duties. (Civil
SPECIAL
American Red Cross relief services in Louisiana for
Service Rule 11:21.1)
Act of God: appointing authority determines the employee
disasters designated as Level III or above in the American
is prevented by an act of God from performing duty.
Red Cross Regulations and Procedures. Must be certified
OTHER
as a Trained Disaster Volunteer and approved by
Any other special or non-chargeable leave request as
appointing authority.
provided in Chapter 11 of the C.S. Rules.
Voting: leave granted when voting in a primary, general or
special election which falls on regular scheduled work days,
provided not more than two hours of leave shall be allowed
to vote in the parish where he is employed and not more
than one day to vote in another parish.
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