ࡱ> LNKO 5bjbjgQgQ 88;e;e vvl;#rO^T~h;#=#=#=#=#=#=#$j& )a#Q<"^a#?#;#;#!'"xy.!'##0#!,***'"'"*;"a#a##*v :  NICHOLLS STATE UNIVERSITY Form LP2 5/2025 APPLICATION FOR USE OF LEAVE POOL HOURS  FORMCHECKBOX  CRISIS LEAVE POOL (CLASSIFIED AND UNCLASSIFIED STAFF)  FORMCHECKBOX  SICK LEAVE POOL (FACULTY AND UNCLASSIFIED STAFF) Name:  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Phone Numbers: NSU  FORMTEXT       FORMTEXT       Home  FORMTEXT       FORMTEXT       Employee ID:  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Cell  FORMTEXT       FORMTEXT       I am requesting to use  FORMTEXT       hours from the Leave Pool indicated above. I certify that I meet eligibility requirements stated in Nicholls State University s Policy and Procedure for this program. In accordance with the Policy, I have attached written documentation to support the need for leave (including documentation from a Licensed Medical Service Provider if for illness/condition of self, or eligible family member if applying for crisis leave), and my personal statement explaining my request. I understand that, if approved, the maximum number of days/hours that I can draw from the Program is limited to 30 days or 240 hours of annual leave per fiscal year (Crisis Leave Pool for Classified and Unclassified Staff ) 22 days or 176 hours of sick leave per fiscal year (Sick Leave Pool for Faculty and Unclassified Staff ) and is also limited to 100 days or 800 hours total participation in the Program. I also understand that this request shall not create a legal entitlement. Signed: _____________________________________________ Date: ____________________________ INSTRUCTIONS for applying for leave through the pools: (1) Forward this Application for Use of Leave Pool Hours (LP2) and all relevant documentation directly to the Director of Human Resources. (Supporting documentation must be submitted to the Director of Human Resources at the time of application.) (2) As committee chair, the Director of Human Resources will forward the application and related documents to the Review Committee. (3) The Review Committee will review the application and documentation and decide to approve or deny the request. (4) The Director of Human Resources (or designee) will notify the employee, the supervisor, and payrollg h k l m n ¶qdXP>XP6hnOJQJ#jh|huOJQJUh|OJQJjh|OJQJUhy6CJOJQJaJhGj4h|5CJOJQJaJh, 5CJOJQJaJhJh>*CJOJQJaJhICJOJQJaJh3CJOJQJaJh{CJOJQJaJhJCJOJQJaJhJ>*CJOJQJaJh>*CJOJQJaJhuCJOJQJaJhCJOJQJaJn D F l  }X\\]^ $ & Fa$gdn$a$gd|gd|$a$gd|gdJgd   @ B D F T V j l n x | ǺqW?W.j\hqh|>*CJOJQJUaJ3jhqh|>*CJOJQJUaJmHnHu.jhqh|>*CJOJQJUaJhqh|>*CJOJQJaJ(jhqh|>*CJOJQJUaJh|CJOJQJaJh|>*CJOJQJaJh|h|OJQJ#jth|huOJQJUjh|OJQJUhnOJQJh|OJQJ      ( * , 6 : N P R \ ^ ۑyaI.jhqh|>*CJOJQJUaJ.j,hqh|>*CJOJQJUaJ.jhqh|>*CJOJQJUaJ.jDhqh|>*CJOJQJUaJ3jhqh|>*CJOJQJUaJmHnHu.jhqh|>*CJOJQJUaJhqh|>*CJOJQJaJ(jhqh|>*CJOJQJUaJ^   4 6 8 B F Z ǷDžǷmDž^ǷFDžǷ.jh hF(k>*CJOJQJUaJh h|CJOJQJaJ.jh hF(k>*CJOJQJUaJ3jh h >*CJOJQJUaJmHnHu.jh hF(k>*CJOJQJUaJh h >*CJOJQJaJ(jh h >*CJOJQJUaJhF(kCJOJQJaJh5CJOJQJaJh CJOJQJaJZ \ ^ h j l ӹӪyaGy/Gy.j`hqh|>*CJOJQJUaJ3jhqh|>*CJOJQJUaJmHnHu.jhqh|>*CJOJQJUaJhqh|>*CJOJQJaJ(jhqh|>*CJOJQJUaJh|CJOJQJaJh h|CJOJQJaJ3jh h >*CJOJQJUaJmHnHu(jh h >*CJOJQJUaJ.jvh hF(k>*CJOJQJUaJ     4 6 8 B F Z \ ^ h l ӹөӹөyӹөaӹөIӹ.jhqh|>*CJOJQJUaJ.j8hqh|>*CJOJQJUaJ.jhqh|>*CJOJQJUaJ.jLhqh|>*CJOJQJUaJhqh|>*CJOJQJaJ3jhqh|>*CJOJQJUaJmHnHu(jhqh|>*CJOJQJUaJ.jhqh|>*CJOJQJUaJ  8ëӑyӑj]QBhuJ h|CJOJQJaJh|CJOJQJaJhy>*CJOJQJaJh h|CJOJQJaJ.j h hF(k>*CJOJQJUaJ3jh h >*CJOJQJUaJmHnHu.j$ h hF(k>*CJOJQJUaJh h >*CJOJQJaJ(jh h >*CJOJQJUaJhF(kCJOJQJaJh CJOJQJaJ8:NPR\^.`bdfh|~=`뚋|||mm|m|m^O@huJ h0#CCJOJQJaJhuJ hI{CJOJQJaJhuJ huCJOJQJaJhuJ hCm'CJOJQJaJhuJ h+CJOJQJaJhuJ hyCJOJQJaJhuJ h|CJOJQJaJ3jhuJ h|>*CJOJQJUaJmHnHu.j huJ h|>*CJOJQJUaJhuJ h|>*CJOJQJaJ(jhuJ h|>*CJOJQJUaJ|}ĸvj[O[OChuJ CJOJQJaJhGCJOJQJaJhuT0hGCJOJQJaJhGCJOJQJaJhG3huJ CJOJQJaJ"h_huJ 5>*CJOJQJaJ"h_ho5>*CJOJQJaJhuT0huJ CJOJQJaJhGCJOJQJaJhuJ h|CJOJQJaJhuJ hd"mCJOJQJaJhuJ h0#CCJOJQJaJhuJ huCJOJQJaJ !#27VWX[\\ⲦsdTE9h|CJOJQJaJhuJ hd"mCJOJQJaJh_h|5CJOJQJaJhvhuJ CJOJQJaJhG3CJOJQJaJhuJ CJOJQJaJhGCJOJQJaJhuT0hGCJOJQJaJhGCJOJQJaJhuJ h|CJOJQJaJ"h_huJ 5>*CJOJQJaJhuT0huJ CJOJQJaJhuT0h|CJOJQJaJhuT0hvCJOJQJaJ\]^_kxy}>BWbɹzjz^RzhnCJOJQJaJhJCJOJQJaJhnhN@>*CJOJQJaJh{CJOJQJaJh^CJOJQJaJh^CJOJQJaJhoCJOJQJaJh^hN@CJOJQJaJh^hN@5CJOJQJaJh^h|5CJOJQJaJhG3hG3CJOJQJaJhG3CJOJQJaJh^CJOJQJaJ ^_444455]55555gd^$a$gd}gdN@gdJ$a$gdN@$a$gd|!6ABQhn4*4+4444444444嚘sg[htCJOJQJaJh|CJOJQJaJ*jh|CJOJQJUaJmHnHuhJh|CJOJQJaJUhpCJOJQJaJh~`UCJOJQJaJh{CJOJQJaJh^h{CJOJQJaJhJCJOJQJaJh^CJOJQJaJh^hN@CJOJQJaJhnCJOJQJaJ! in writing of the committees decision to approve or deny the request. A copy of the notification will be sent to the employees immediate supervisor, and the Payroll Office.  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