Fillable LEAVE FORM Employee Position Date(s) of Absence Mark (Mississippi Delta Community College)

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LEAVE FORM Employee Position Date(s) of Absence Mark (Mississippi Delta Community College)

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LEAVE FORM
Employee Position
Date(s) of Absence
Reason for Absence:
Mark appropriate reason for leave (leave balances are available on BANNER)
Medical – FILE WITHIN TWO WORKING DAYS OF THE LAST DAY OF ABSENCE
(you earn 10 hours per month)
Personal (2 days may be used for personal use)
Annual/Vacation (applies to 12 month employees only) – FILE SEVEN DAYS IN ADVANCE OF
ABSENCE (you earn 7 hours per month)
Administrative/Professional Leave, (ALL out-of-state travel must go before the Board) You MUST
complete the following: Please provide any pertinent information needed for determining approval
for leave.
L
ocation:
Administrative/Professional – FILE SEVEN DAYS IN ADVANCE OF ABSENCE
Yes, a vehicle is needed for travel (Must complete vehicle reservation form)
No vehicle is needed
Employee Date Filed
Director / Supervisor / Division Chair Date Received
Associate Vice President / Vice President Date Received
President Date Received
Mississippi Delta Community College does not discriminate on the basis of age, race, color, national origin, religion, sex, sexual
orientation, gender identity or expression, physical or mental disability, pregnancy, or veteran status in its educational programs
and activities or in its employment practices. The following person has been designated to handle inquiries regarding the
nondiscrimination policies: Steven J. Jones, Vice President of Administrative Services, Tanner Hall, Suite 202, P. O. Box 668,
Moorhead, MS 38761, 662-246-6304; EEOC@msdelta.edu
Revised 11/17/2020
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LEAVE FORM Employee Position Date(s) of Absence Mark (Mississippi Delta Community College)

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Completed 3 February 2021

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