Employee Absence/PTO
Submission Form
Employee Name
*
Start Date
*
/
Month
/
Day
Year
Date
End Date
*
/
Month
/
Day
Year
Date
Total Number of Days (or fraction there of, e.g. .25 or .5 days)
*
Reason for Absence
*
Sick
Simcha
Other/Personal (specify below)
Specify Absence
*
Employee Name
*
Start Date
*
/
Month
/
Day
Year
Date
End Date
*
/
Month
/
Day
Year
Date
Total Number of Days
*
Covid Related
*
Yes
No
Reason for Absence
Would you like to add another instance?
*
Yes
No
Employee Name
*
Start Date
*
/
Month
/
Day
Year
Date
End Date
*
/
Month
/
Day
Year
Date
Total Number of Days
*
Covid Related
*
Yes
No
Reason for Absence
Would you like to add another instance?
*
Yes
No
Employee Name
*
Start Date
*
/
Month
/
Day
Year
Date
End Date
*
/
Month
/
Day
Year
Date
Total Number of Days
*
Covid Related
*
Yes
No
Reason for Absence
Would you like to add another instance?
*
Yes
No
Employee Name
*
Start Date
*
/
Month
/
Day
Year
Date
End Date
*
/
Month
/
Day
Year
Date
Total Number of Days
*
Covid Related
*
Yes
No
Reason for Absence
Would you like to add another instance?
*
Yes
No
Employee Name
*
Start Date
*
/
Month
/
Day
Year
Date
End Date
*
/
Month
/
Day
Year
Date
Total Number of Days
*
Covid Related
*
Yes
No
Reason for Absence
Submitted by
Supervisor
*
Please Select
Rabbi Aharon Rubenstein
Rabbi Aryeh Davidowitz
Rabbi Yermiyahu Ornstein
Dr. Mia Ozair
Mrs. Tamarah Yuz
Mrs. Aida Forman
Mrs. Shaina Davidowitz
Other
Full Name
*
First Name
Last Name
Supervisor Email Address
*
example@example.com
Supervisor Signature
*
Today's Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: