Time-Off Request
Updated 07.17.23
I am requesting...
*
Paid Leave (If Available)
Unpaid Leave
Employee Name
*
Please Select
Jairo
Miguel
Carlos
Sisa
Department
Please Select
Admin
Sales
Editorial
Hola in the Morning
Video
Graphics
Date Employment Started
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date(s) requested off
*
Type it like this: 08.21.21-08.22.21
Total Hours-Off Requested
*
Last Day to be Worked
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Return Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Request:
Vacation
Medical / Dental
Child-Related (sick, doctor, etc)
Personal Day / Sick
Other (detail below)
Details (if needed):
Include exact times you will be away from work in this box if you are not missing an entire day.
If you are taking a half-day, choose one:
I will miss the first half of the day
I will miss the last half of the day
Alternate Contact Information:
(If your regular contact information will not work)
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: