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Unpaid Leave of Absence: Employee Request to Department Head (for all Appointed Personnel - Faculty, Administrative, and Professional)

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Date To Be Issued

Employee's Name (Do not address to Human Resources or Employee File)

Employee's Title:

Requesting Dept Head:

Briefly state reason for Leave of Absence request.

Leave of Absence start date:
(date after last day of work)

Leave of Absence end date:
(leave cannot exceed one year)

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For HR Professionals \| Who to Call for What \| Privacy Statement © 2005, Arizona Board of Regents \| Contact the Human Resources Department University of Arizona \| University Services Building, 888 N. Euclid Avenue, Room 114, Tucson, AZ 85721-0158 520.621.3662 (phone) \| 520.621.9098 (fax) \| Page last updated July 26, 2005 .

© 2005, Arizona Board of Regents
University of Arizona | University Services Building, 888 N. Euclid Avenue, Room 114, Tucson, AZ 85721-0158
520.621.3662 (phone) | 520.621.9098 (fax) | Page last updated June 12, 2007