Leave Without Pay Request Form

You have chosen the Leave Without Pay Request Form.

This form can only be signed by the department's Leave Without Pay approver (Department Director, Supervisor, or Timekeeper) on behalf of the employee requesting LWOP.

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By continuing I acknowledge that I am an authorized leave without pay approver. I agree that I am willing to complete a digital version of the document and that information about my user session will be stored.

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07/20/2025Click to Sign

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County of Wayne

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Leave Without Pay Request Form

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