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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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Name
*
Your answer
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
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