Due to inclement weather, VHCC will be on a snow schedule Wed, Jan. 17, 2018.

Leave Form (Application for Leave of Absence)

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These forms must be completed in either black or blue ink.  No correction fluid may be used.  If it is necessary to make a correction on the time card, please neatly draw a line through the erroneous entry and write the correct information above the error.  The employee's supervisor must initial all corrections.

The forms should be submitted to the Payroll Office (Room 106, ADM Building) with the VHCC TIME RECORD CARD covering the period in which the leave is taken.  It is the supervisor's responsibility to see that the forms are calculated accurately and have been completed properly.

All leave categories marked with an asterisk which includes:  Annual Leave, Civil and Work-Related Leave, Community Service Leave, Compensatory/Overtime Leave, Family and Personal Leave, and Military Leave are to be approved in advance by the Supervisor.  As circumstances warrant, supervisors may approve leave verbally and note verbal approval on comment line of leave form.  Sick leave forms are to be completed and submitted to supervisor upon return to work.  Please submit different types of leave and leave taken on non-consecutive days on separate leave forms. 

Items to be completed are detailed below; instructions for each of the numbered areas are listed below the image:
Leave Form

  1. Employee's Name - PLEASE PRINT.
  2. Employee's Signature.
  3. Employee Number or Last 4 Digits of Social Security Number.
  4. Date the form is submitted by the employee to his/her supervisor for approval.
  5. Number of hours of leave requested (must be submitted in tenths of an hour; use the chart below to convert minutes into tenths of an hour) OR
  6. Number of days of leave requested.
  7. Time and date leave begins.
  8. Time and date leave ends.
  9. This section is used by employees who are still on the "Standard" Leave program and did not convert to VSDP.
  10. This section is used by VSDP participants.
  12. Date of Supervisor's signature.  Current date only.
  13. Supervisor's signature recommending that leave be granted as requested by the employee.
  14. For Human Resources use only.
Conversion of Minutes to Tenths of an Hour



1 - 6


7 - 12 


13 - 18


19 - 24


25 - 30


31 - 36


37 - 42


43 - 48


49 - 54


55 - 60