Free 00056.FH11 - Indiana

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REQUEST FOR LEAVE
State Form 56 (R6 / 7-06)

Date (month, day, year)

INFORMATION: 1. This leave request form is available for internal use by state agencies. 2. This form can be obtained from the Central Printing Services or online at the State Forms Catalog.
Name of employee Signature of employee Type of leave requested Vacation Dates requested From Comments Signature of supervisor Personal Sick through Military Compensatory Time-off Start time of absence Family Leave End time of AM absence PM Other _______________________________________ Requested leave hours Balance of hours after this AM request PM Title Division or location

Approved Denied Canary - Supervisor;

Date

Signature of approving authority

Approved Denied

Date

DISTRIBUTION: White - Approving Authority;

Pink - Employee