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Reset Form APPLICATION FOR LEAVE Employee Information: Agency/Department: Employee Name: Number of Hours of Leave Requested: From Date: Time: AM To Date: Time: PM AM PM Leave Information: Chargeable Leave Annual Leave Sick Leave LWOP If FMLA, select one of the following: Self Military Caregiver Family Qualifying Exigency Military Job Related Education Other (explain in comments) Non-Chargeable Leave Civil: Special: Jury Duty Funeral Witness Subpoena Office Closure Emergency Civilian Job Related Exam Voting Comments: If Part-Time, list number of hours worked each day..
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