Time Off Request Form
Office must receive request your request at least 2 weeks in advance.
Request for (name):
*
NOMBRE
Put only days you can't work
Nomas Ponga dias que quire pedir no trabajar
Day Off Needed
*
-
Month
-
Day
Year
Este Dia Necesito
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Type of Day Off:
*
Doctor appointment.
Family (severe sick or death)
Jury Duty
Personal
Reason:
Date returning to work Please:
-
Month
-
Day
Year
Date
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
Total Days Off:
Submit
Should be Empty: