Sick Leave Request (Extraordinary Use)

WAIVER STAFF: %staff_first% %staff_last% (%employee_id%)

WAIVER RECIPIENT: %recipient_first% %recipient_last% (%consumer_id%)

SUPERVISOR: %supervisors%

I am requesting extraordinary use of sick leave because the individual I am regularly scheduled
to work with has been: %Place%

Please provide a detailed description of the circumstances which require you to be off with
the individual served: %circumstances%

I wish to be considered for fill-in work with other individuals or departments while I am unable
to work my regular schedule: %Fill_in%

I understand that if I do not have enough sick leave accrued to cover my scheduled hours
I will need to use vacation time. I understand that in the absence of sufficient accrued sick/vacation
hours my leave will be unpaid: %understand_leave%

I understand that if my request is approved I will need to submit a time sheet: %understand_timesheet%

request submitted: %_sfm_form_submision_time_%