Request for Time Off
Employee Name
*
Please Select
Alisha Rosa
Lolita Harper
Phil Jonas
Jeff Simonton
Chris Lee
Debra Plamondon
Yohana De La Cruz
Kristy Ramirez
Claudia Vazquez
Alyssa Reese
Layla Moncada-Terreros
Julieta Ramirez
Employee Email
*
example@seba.com
Who is your supervisor?
*
Leave Type
*
Please Select
Sick
Vacation
Administrative
Bereavement
Floating Holiday
Personal Leave
Jury Duty
Cancel Time Off Request
Other
Time Off Starting Date
Number of Hours You Plan to Take Off:
Message (If necessary)
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Should be Empty: