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Leave Request (Requiring ERSC Authorization)

About this Form

Form number: 430-1

Audience:  MCPS Staff

Last revised: May 2012

Related Forms

Form 430-1A - Leave Request (NOT Requiring ERSC Authorization)

Form 430-1A2 - Leave Request (NOT Requiring ERSC Authorization)

Form 430-94 - Professional Leave (PRO)

To be completed when an employee is requesting leave of 5 days or more, except annual or personal.

INSTRUCTIONS: Please complete form, discuss leave plans with immediate supervisor, obtain signatures, attach proper documentation, and forward to ERSC. You must submit page 2 with appropriate signatures. Keep a copy for your records. Refer to reverse side for detailed instructions. Understanding of leave policies is your responsibility. Going on leave may impact your benefits and costs, sometimes significantly. Make sure you understand the potential impact by reading this form thoroughly and reviewing the Employee Benefit Summary for leave rates. Bereavement leave requests in excess of the contract allowance should be submitted on this form.

Adobe PDF Leave Request (Requiring ERSC Authorization)139 KEnglish

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