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Time Off Request
Please submit the times you need to take off work at least 2 weeks prior and allow 48 hours for approval.
2024 BLACKOUT DATES:
May 3rd
May 15th
May 24th
June 10th
June 20th-28th
July 15th-19th
August 16th
November 22nd
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* Indicates required question
Name
*
Your answer
Leave date(s)
*
MM
/
DD
/
YYYY
AM/PM/All day
*
AM
PM
Full day
Type of leave
*
Sick leave (Illness or Injury)
Bereavement leave (Immediate Family)
Bereavement leave (Other)
Personal leave
Jury duty or legal leave
Emergency leave
Temporary leave
Other:
Reason for leave
Your answer
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