1. Sheet1

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2 Compensatory Leave Approval Form            
3 for Unclassified Administrators/Staff            
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5         Department:      
6 Employee:       Department Code:      
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8 REQUEST TO EARN COMPENSATORY LEAVE     ACTUAL COMPENSATORY HOURS        
9 Dates Hours   Dates Hours Worked   Total  
10 Requested Requested Description of Work Worked From To Hours  
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24 The above named employee has been approved to earn compensatory leave for the days and times listed.     I certify that I have worked the above listed hours.        
25         Employee's Signature: _________________________________   date__________  
26       I hereby certify that the above listed employee has earned compensatory leave in accordance with College Policy.        
27 Immediate Supervisor/ Department Head ______________________________________ date_________     Immediate Supervisor/ Department Head ______________________________________     date__________  
28 Dean/ Executive Dean/ _________________________________ date _________
Assistant Vice Chancellor/ Vice Chancellor/ Chancellor (as appropriate)
    Dean/ Executive Dean/ __________________________________
Assistant Vice Chancellor/ Vice Chancellor/ Chancellor (as appropriate)
    date__________  
29                
30             Form 2400/004 (8/11)  

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