Leave of Absence Forms Instructions

Purpose

This form is used to place a regular biweekly or monthly paid (non-DOF) employee on a non-disability leave of absence.

Helpful Hints

If the employee has requested an intermittent family/medical leave, please contact your Office of Human Resources.
Pay attention to payroll deadlines.
Refer to Reason definitions when selecting Reason for leave from the drop down list.

Procedure

Check appropriate Current Staff check box. (required)

If a correction to a previously submitted form, check the correction box and provide an explanation. (optional)

Complete all fields in Section I – Employee Information. (required)

If employee is going out on a leave of absence, complete the following fields in Section II – Leave Information:

Begin Leave of Absence Date (required)
Estimated Return from Leave Date (optional)
Check the Unpaid Leave of Absence or the Paid Leave of Absence check box (required)
Select a Reason from the corresponding drop down box (required)

If return from leave date is known at the start of the leave, complete Section III at the same time you complete Section II. If the return from leave date is not known, submit a separate leave of absence form as soon as the employee returns

If the employee is returning from leave, complete the following fields in Section III – Return from Leave:

Return from Leave Date (required)

Check the Returned from Leave in the Same Month or Returned in a Different Month (required for benefits billing purposes)

Comments (optional)

Print completed form

Sign and date the form (required)

Fax or mail to the Office of the Dean of the Faculty or your Office of Human Resources:

Office of the Dean of the Faculty - 8-2168, 9 Nassau Hall

Main Campus HR - 8-2420, 1 New South,

Library HR - 8-0454, Firestone Library

PPPL Human Resources - 243-2050, MS33 C-Site