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Time Off Request Form '19 - '20
2019 - 2020 Eleutheria LLC Time Off Request Form
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Email
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Your email
Employee Name:
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Your answer
Title:
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Your answer
Supervisor:
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Your answer
PLEASE COMPLETE THIS FORM FOR THE DAY(S) YOU ARE REQUESTING TIME OFF. You must submit requests for absences (except sick leave) at least 7 days prior to the first day that you will be absent.
Type of Absence:
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Sick
Vacation
Time Off Without Pay
Bereavement
Jury Duty
Military
Maternity/Paternity
Other:
Which date(s) are you requesting off? Please list all dates if more than one is being requested. (Month/Day/Year)
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Your answer
Reason For Absence:
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Your answer
How many total school setting hours will your absence request be for? Please include total number of hours across all dates you are requesting off.
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Your answer
How many total Wellness Center hours will your absence request be for? Please include total number of hours across all dates you are requesting off.
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Your answer
Enter any concerns or notes about your absence request below (Optional):
Your answer
By entering your name in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge:
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Your answer
Today's Date:
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