ABBREVIATED LEAVE FORM

ABBREVIATED LEAVE FORM
Employee Name*
Employee Email*
example@example.com
Request Date

MonthDayYear
Date
Reason for Request*
Time & Date to Arrive Late/Leave Early(before 8:30 AM or after 2:00 PM ONLY)
Late/Early

Arrive LateLeave Early
Late/Early Date*

MonthDayYear
Date
Late/Early Time*

Hour Minutes

AM/PM Option
Time & Date absence will be made up (within 5 working days of absence)
Time & Date absence will be made up (within 5 working days of absence)*

MonthDayYear
Date
Hour MinutesAM/PM Option
Employee Signature*
Date

MonthDayYear
Date
For Administrative Use Only

Request ApprovedRequest Denied
Administrator Signature
Date

MonthDayYear
Date
Should be Empty:

Time & Date to Arrive Late/Leave Early(before 8:30 AM or after 2:00 PM ONLY)