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APPENDIX F <br />Hugo Fire Department Leave of Absence Form <br />Please complete the Leave of Absence form. All requests for leave shall be submitted and <br />delivered directly to the City Administrator at the Hugo City Hall for interim approval. Final <br />approval shall be made by the City Council at the subsequent council meeting. The firefighter <br />leave of absence request shall comply with Section 11.25, Leave Of Absence for Firefighters, in <br />the Hugo Personnel Policy. <br /> <br />Name: <br /> <br />Address: <br /> <br /> <br /> <br />Phone Number: <br /> <br /> Please mark (x) on the leave of absence you are requesting: <br /> <br />Personal Leave ________ Medical Leave ________ Military Leave ________ <br /> <br /> Please mark (x) on the type of leave of absence you are requesting: <br /> <br />Full ________ Partial <br /> <br /> Reason for Leave: <br /> <br /> Date of absence and anticipated date of return: <br /> <br /> <br />Firefighter Signature: Date of Request: <br /> <br /> <br /> <br /> <br /> <br />FOR INTERNAL OFFICE USE: <br /> <br />Interim Approval: <br /> <br /> <br />City Administrator Signature Date <br /> <br /> <br />Council Action: <br /> <br />Approved Denied <br /> Date