N.M. Admin. Code § 9.4.7.24
Current through Register Vol. 35, No. 17, September 10, 2024
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