Request for Leave

Employee Name: Jeff Brotherston

Employee Number: 201898

Position/Title: Labourer

Department: Parks
*Name of employee backfilling for
you during your leave:
*provide name of your immediate Manager/Supervisor if this is not applicable to you.

Request for leave to be approved by a Management Supervisor. Please check your pay stub for time available in
each category.

Number From To
of Days
Vacation Leave 4 Sept 8, 2020 Sept 11, 2020

Prior Year’s Vacation

Supplementary Vacation

Banked Overtime

Banked Standby

Other (explain)

Note: Pay will be deposited to your account on Pay Day.

Employee Acknowledgment:
st
Should I leave the City of Surrey prior to December 31 of this year, I authorize an adjustment to be made on my
final pay to compensate for any vacation days taken but not earned.

Aug 19, 2020

Employee Signature Date

Management Approval Date

(Approved original to employee, copy for the department timekeeper)

Date modified: August 27, 2018 City of Surrey Human Resources

Employment Form