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Time Off Request Form
Please fill out this information to the best of you ability.
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Name (first, last)
Your answer
Leave start time and date (ex. 9:00AM on 03/16/21)
Your answer
Leave end time and date (ex. 9:00AM on 03/16/21)
Your answer
Use paid time off?
Yes
No
Clear selection
Type of leave (choose one)
Vacation
Sick leave (Illness or Injury)
Bereavement leave (Immediate Family)
Bereavement leave (Other)
Personal leave
Jury duty or legal leave
Emergency leave
Temporary leave
Leave without pay
Other:
Clear selection
Submit
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