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Leave Request
1
Name
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Name
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2
Date of Leave
*
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Date
Year
Month
Day
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3
All day?
*
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YES
NO
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4
From
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45
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Minutes
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5
To
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Hour
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45
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45
Minutes
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6
More than one day?
*
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7
To Date
*
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Date
Year
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Day
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8
Reason
*
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Vacation
Personal Time
Medical Appointment
Illness
Accident on the Job
Jury Duty
Leave Without Pay
Other
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9
Comments
...if applicable...
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