Leave Without Pay Request/Authorization
Classified Staff Employees (DER-C&C-20)
Classified Staff Employees use this form to apply for or extend a leave of absence
without pay for any of the following reasons: Maternity; Paternity or Adoption;
Medical; Educational; Filing Unclassified Position; Exceptional Personal Reasons;
Other Work. When the leave is medical, a Family and
Medical Leave Act (FMLA) form
must also be submitted. It is also used to certify that an employee has presented
evidence that he/she has enlisted or is inducted or ordered into active service of
the armed forces of the United States, or the employee's services have been
specifically requested by the federal government for national defense work during
a national emergency and is entitled to military leave without pay under
provisions of ss.230.32, Wis. Stats.
The form should be submitted to the supervisor for consideration and further
submission to the apppointing authority and finally the Department of Human
Resources.
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Last modified: July 13, 2006