ATLANTA POLICE DEPARTMENT

Sick Leave Request

Date
Chief George N. Turner

Atlanta Police Department

Atlanta, Georgia

Dear Chief Turner:

I respectfully request that I be paid full salary for the following days that I was absent from duty, in accordance with the ordinance of the City of Atlanta:

Date(s) absent:

Please charge this to Sick Leave Injured on Duty Time.

My shift is Eight (8) Hours Ten (10) Hours.

I was absent for the following reason(s):

Endorsements

Immediate supervisor: approve/ disapprove.
Employee Printed Name
Employee Position Number

Immediate Supervisor’s Signature

Division

Commanding officer: approve/ disapprove.
Section, Zone, Squad, or Detail

Commanding Officer

Watch or Unit

Respectfully,	Section Commander: approve/ disapprove
Employee Signature	Section Commander’s Signature

Copy - Personnel

Copy- Section Commander

Copy - Employee

Form APD 223 Formerly 32-G-106 Revised 11/6/09

ATLANTA POLICE DEPARTMENT

vlivsey

2010-09-24

Atlanta Police Department