N.M. Admin. Code § 9.4.7.24

Current through Register Vol. 35, No. 20, October 22, 2024
Section 9.4.7.24 - APPENDIX 13: COMMISSION FOR THE BLIND BUSINESS ENTERPRISE PROGRAM

APPLICATION FOR LEAVE

Licensed Manager Name:___________________ Facility No.______

Date________

________________________________________________________________________________________

Type of Leave:

_____ ANNUAL START DATE______ ENDING DATE_____TOTAL HOURS_____

_____*SICK START DATE______ ENDING DATE_____TOTAL HOURS_____

TOTAL HOURS ____

________________________________________________________________________________________

____________________________ ____________________________

Licensed Mgr. Signature Date BEP Manager Signature Date

*Any request for five days or more of sick leave must be accompanied by a release form from the doctor.

N.M. Admin. Code § 9.4.7.24

4/15/97; Recompiled 10/01/01