TIME & LEAVE BALANCE REQUEST 

 

 

NAME 
(NAME) 




DATE: 
(DATE) 




DEPARTMENT 
(DEPARTMENT) 




TITLE 
(TITLE) 




EXT 
(EXT) 






I am requesting a summary of all my current Leave Balances. All of my timesheets have 
been submitted to the HR Office. 

 

The turnaround time is 2 Business Days. 

 

 

 FOR OFFICE USE ONLY

 

Time & Leave as of ACCRUAL RATES
(Time & Leave as of) 


 


(A.L. Monthly Accrual Rate) 
D Annual Leave 
(Annual Leave) 
D 
(D) 
H 
(H) 
M A.L. Monthly Accrual Rate 
(D) 
H 
(H) 
M 

 


(S.L. Monthly Accrual Rate) 
D Sick Leave 
(Sick Leave) 
D 
(D) 
H 
(H) 
M S.L. Monthly Accrual Rate 
(D) 
H 
(H) 
M 

 


(Annual Leave Cap) 
Unscheduled Holidays 
(Unscheduled Holidays) 
Annual Leave Cap 


(A.L. Yearly Accrual) 
D Compensatory Time 
(Compensatory Time) 
A.L. Yearly Accrual 

 


(Date Sent) 
S.L. Yearly Accrual Date Sent 
(S.L. Yearly Accrual) 
D 

 

Completed by: 
(Completed by) 
* D= Day/s H=Hour/s M=Minutes* 

 

 

Request Made: Phone___ / Email 
/ By Supervisor ___ / In Person ___