Time-Off Request Form

Name (first, last) *

Leave start time and date (ex. 9:00AM on 03/16/21) *

Leave end time and date (ex. 5:00PM on 03/16/21) *

Use paid time off? *YesNo

Type of leave (choose one) *VacationSick leave (Illness or Injury)Bereavement leave (Immediate Family)Bereavement leave (Other)Personal leaveJury duty or legal leaveEmergency leaveTemporary leaveLeave without payOther:

Send