Information about the Leave of Absence form
Note: Whenever possible the AHRforms web application (pre-populated forms application) must be used to produce this form.
The Leave of Absence form is used to put a faculty/academic staff member on leave. Reference the section on Leaves of Absence in the Faculty Handbook for information on policy, and the types and length of leaves.
Name: As recorded on the Social Security card, except type last name first with a comma after, and then the rest of the name.
Social Security #: Double check for accuracy.
Date: Typing date.
Position #: Use the full position # (letters which designate the MAU plus the number).
Academic Year/Annual Year: Appointment basis which is in effect as of the beginning date of the leave.
Position/Rank 1, Position/Rank 2, Position/Rank 3: Position/rank(s) which is in effect as of the beginning date of the leave.
Title 1, Title 2: Title(s) which is in effect as of the beginning date of the leave.
Executive Management: Check the box if the employee is in an executive management position as of the beginning of the leave.
Position/Rank/Title (freeform, optional): This line can be used to further specify a position/rank and/or title as of the beginning of the leave. For example, the position/rank of "coach" can be specified as "Women's Volleyball Coach"; a title of "director" can be further specified as "Director of Graduate Studies". This is limited to 30 characters.
Appointment Status: Appointment status which is in effect as of the beginning date of the leave.
Department/College: The department(s), College(s) in which the employee is appointed as of the beginning date of the leave. Type out the full department name or the 18 character common unit code abbreviation. For the department code, use the three-digit department common unit code; for the college code use the two-digit college common unit code.
Continuing Employment Date: The continuing employment date is the beginning date of paid (1% or more) continuous employment. Give month, day and year, in that order.
Pay Dates of Leave (for Academic Year Appointments):
(Pay dates of leave for Annual Year appointments are always the actual dates the employee will be on leave.)
1. Leave with full pay for AY: The pay dates are the semester pay period dates for all leaves granted on a semester basis. Pay dates for medical and other leaves which are not in semester increments should be the actual dates the faculty/academic staff member is on leave.
| Semester |
Duty Period and Pay Period |
|
Fall Semester |
August 16 - December 31 |
2. Sabbatical leave with half pay for AY:
| Leave Begin | Duty Period and Pay Period |
|
Fall Semester: |
August 16 - May 15 |
|
Spring Semester: |
January 1 - May 15 and August 16 - December 31 |
3. Leave with no pay for AY:
| Leave Period | Pay Dates of Leave |
|
Fall Semester: |
August 16 - December 31 |
|
Spring Semester: |
January 1 - May 15 |
|
Full Year beginning Fall: |
August 16 - May 15 |
|
Full Year beginning Spring: |
January 1 - May 15 and Aug 16 - December 31 |
Type of Leave: Check one box. For sabbaticals, also provide the locale and check one of the sabbatical leave pay boxes which are indented under the locale lines. For policy statements covering various types of leaves, see the Faculty Handbook.
Authorized Pay (Other Than Sabbatical): Check one box for any leave other than a sabbatical.
If "No Pay" is checked, also check one of the boxes after "If no pay, does the leave qualify under the Family and Medical Leave Act of 1993" If the leave without pay is covered by the FMLA, (such as paternity leave) check the "yes" box.. Checking the "yes" box results in the continuation of benefits while on the FMLA leave without pay. For leaves without pay that are not covered by the FMLA, check the "no" box.
Comments: Fill in any explanation necessary to justify the recommended action.
Recommended by: Signatures must be the chairperson/director's and dean/MAU administrator's name with any other initials below. In the case of a multiple appointment the signatures for each unit involved are required. Each signer must date her/his signature.
Provost Comments: Leave blank. This information will be filled in by Academic Human Resources staff if it is applicable.
Routing: All departments and colleges involved; Academic Human Resources; Provost Office; Academic Human Resources and Payroll. Distribution of copies of approved action: Academic Human Resources; all colleges involved; all departments involved; faculty/academic staff member
