COURT OF CHANCERY LEAVE REQUEST NAME: _________________________________ VACATION TIME DATE/S HOURS ___________________________ _________ ___________________________ _________ SICK LEAVE DATE/S HOURS ____________________________ _________ ____________________________ _________ REASON FOR SICK TIME _____ Illness _____ Appointment _____Sickness in Family COMPASSIONATE LEAVE _____ Funeral _____Other (Explain)_____________________________ DATE/S __________________________ HOURS __________ EMPLOYEE SIGNATURE _________________________________________ DATE _________________________ APPROVED ___________________________________________________ DATE __________________________ IF NOT APPROVED, REASON ___________________________________________ American LegalNet, Inc. www.FormsWorkflow.com