PLCB-2458 Revised 02/15 ELECTRONIC REQUEST FOR LEAVE Date Submitted 03/25/17

NAME (LAST, FIRST, MIDDLE INITIAL) EMPLOYEE NO. STORE NO.

Doherty,Linda M. 476844 6401

LEAVE CODE HOURS LEAVE BEGIN TIME LEAVE END TIME
DATE DATE
61 37.5 05/15/17 8:30 am 05/21/17 10:00 pm
LEAVE CODE HOURS LEAVE BEGIN TIME LEAVE END TIME
DATE DATE

REMARKS:

APPROVING AUTHORITY SIGNATURE DATE DISAPPROVED

APPROVED

Electronic Leave Request - PLCB-2458

1. An Electronic Request for Leave, PLCB-2458, is required each time a store employee requests Annual
or Personal leave. This leave request should be submitted at least two weeks prior to the requested
leave date whenever possible.

2. The employee must electronically complete the PLCB-2458 and submit it to the District Manager (DM)
for consideration via email. DM will have the discretion to approve or forward to the appropriate
General Manager (GM) for consideration. Instructions for completion of the upper section of the form
are as follows:
a. Date Submitted - must be entered
b. Name - must be typed with last name first
c. Employee No. and Store No. are required
d. Leave Code is required:
Code 61 - Annual Leave
Code 67 - Personal Leave
Code 49 - Hours Unavailable - ILSC only
e. Hours of absence requested are required
f. Leave Begin Date and Time are required
g. Leave End Date and Time are required
h. Remarks are only required when additional information is necessary to support the request, when
the request for absence is used to request a change, or when the form is used to document a
change in absence records.

3. District Manager/General Manager - Instructions for completion of the lower section of the form are as
follows:

a. The DM/GM will respond to the employee within 7 days

b. DM/GM must electronically sign the form
c. The Date field is when the DM/GM approves /disapproves the request
d. Approve or Disapprove box must be checked (click the box) - Note: if disapproved,
reason for disapproval must be indicated in the remarks section of the form.
e. Return completed form to the appropriate email address/account.

Note: If the requestiong employee does not have an email account, they will submit the completed form
via the LB Store email account to the DM. The DM/GM's response will be returned to the LB Store
account.