Time Off Request Form
Office must receive request your request at least 2 weeks in advance.
Request for (name):
*
NOMBRE
Start Date
*
Put only days you can't work
Nomas Ponga dias que quire pedir no trabajar
Day Off Needed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Este Dia Necesito
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Hour
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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
2 digit month, 2 digit day, 4 digit year
Date
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12
:
Hour
00
10
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30
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50
Minutes
AM
PM
AM/PM Option
Total Days Off:
Submit
Should be Empty: