Absence & Time Off Request Form
Your Name
*
First Name
Last Name
Your E-mail Address
*
Requesting To:
*
Leave early
Come in late
Take one day off
Take a few days off
Vacation
Day of the Week:
*
Date:
*
-
Month
-
Day
Year
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Time you will be leaving (or coming in late):
*
Please be specific. ie. "Leaving early at 3:00pm" or "Coming in at 10:00am"
Vacation Start Date
-
Month
-
Day
Year
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Vacation End Date
-
Month
-
Day
Year
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Start Date
-
Month
-
Day
Year
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End Date
-
Month
-
Day
Year
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Reason for Absence
*
When will you make up your absence?
*
Additional Notes. Please be descriptive.
Submit
Should be Empty: