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Booker T. Washington Center Employee Time off Request
Please submit the times you need to take off work and the type of leave you are taking.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Employment Status:
*
Choose
Full-Time
Part-Time
Department
*
Choose
Administration
Afterschool Programs
ESD Program
Human Resources
Maintenance
Programs
Service Desk
Other
Leave date(s)
*
Your answer
AM/PM/All day
*
AM
PM
Full day
Type of leave
Type of leave
*
Description if needed. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum.
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:
Reason for leave
Your answer
Signature
*
Your answer
Date
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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