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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
.
Allow 3-5 days for approval.
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* Indicates required question
Staff Name
*
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Leave date(s)
*
Your answer
Please list the clients and their session times that will be affected.
*
Your answer
Type of leave
*
Please select the type of leave requested.
Sick leave (Illness or Injury)
Personal leave
Jury duty or legal leave
Emergency leave
Other:
If PTO is available, would you like it applied to missed session times?
*
Yes
No
Reason for leave
*
Your answer
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