Time Off Request
Name
*
First Name
Last Name
E-mail
*
Check appropriate box:
*
Illness
Bereavement
Personal
Continuing Education
Medical Appointment
Going to be out a partial day?
*
Yes
No
Day
*
-
Month
-
Day
Year
Date Picker Icon
Time Out
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Time Back
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
First Day Absent
*
-
Month
-
Day
Year
Date Picker Icon
Date Returning to Work
*
-
Month
-
Day
Year
Date Picker Icon
Total Days Out
*
Substitute Scheduled?
*
Yes
Still working on it!
N/A
Sub Name:
Submit
Should be Empty: