ࡱ> ]_\ bjbjO O M_-a-a^XX,^".****u" !!!!!!!$&!!5@u!XX** "X8**!!V @]!*AP. !."0^" !T'']!']!!!}|^"' : Graduate Public Service Internship Program University of Illinois Springfield Leave Authorization Form Instructions: To use non-compensable, non-accumulative sick leave hours and/or personal leave hours to be absent from the GPSI workplace, as defined in the GPSI Policy Manual, you must complete this form either prior to or immediately after the absence. (Please refer to your Intern Agreement form to determine your sick and personal leave allotment.) Do not use this form to request the use of banked hours for absence from the workplace. The tracking of banked hours is the responsibility of the intern and the placement supervisor. The tracking of sick and personal leave hours is the responsibility of the GPSI office. If you have questions, please call Pam McGowan at (217) 206-6158. This form must be signed and dated by both the intern and the GPSI placement supervisor. Please fax, scan and e-mail, or hand deliver this form to the GPSI office by the 15th of each month with your timesheet to: Pam McGowan via Fax: 217-206-7508 or via E-mail:  HYPERLINK "mailto:pmcgo2@uis.edu" pmcgo2@uis.edu  FORMCHECKBOX Requested Sick Leave: _____ Hours ________ Date  FORMCHECKBOX Requested Personal Leave: _____ Hours ________ Date PLEASE PRINT: UIN: ___________________________________ _________________________________________ _______________________________ Last Name First Name _________________________________________ _______________________________ Intern Signature Date _________________________________________ _______________________________ Supervisor Signature Date  GPSI Office Use Only +,BCOQijkxz % & W X ] j         & ǿxthwh}hM'>* h}hM'h} h}h}hM!hAK h}hlvw h}h7h}h7>*h7hM'h]5:>*hQ5:>*h75CJaJ hM!5hM'h75hM'hH5hM'h]5#jhM'h75UmHnHu-,OPQjk ( l m n    - . gd}$a$gdlvw ^`gdgdwgd`gd7$a$gd7$a$gd7& ( + }     # ' ( + , 6 7 Z [ i j k l m n o } ~  꼳ꯧvnfhQhlvw5hQh}5jhQhAK5UhQhAK5jhQhAK5UhQhM'5CJaJh}CJaJhlvwhV0hw0JjhwUhwhw5hwh`5hhwhw5>*hwhwH*hwh` h}hM' h}hlvw&       , - 3 4 C H Y Z n o | 磳痒{t{t{t{pi{i{ h}hM'h} h}hjgV h}hlvwh}h7>*h}hlvw>* hw>* h}h7 hQ5jthQhAK5UjhQhAK5UhQhM!5 h75 h5hQh}5hQh75 hM!5hQhAK5hQhlvw5hQhM'5). 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