Employee Leave/Coverage Request Form
FIRST AND LAST NAME
*
YOUR EMAIL ADDRESS
*
example@example.com
TYPE OF LEAVE REQUESTED
*
Sick/Bereavement
Personal
Other
DATE REQUESTED
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
AMOUNT OF TIME REQUESTING
*
FULL DAY
HALF DAY
Other
WHAT TIME WILL YOU BE LEAVING/ARRIVING?
*
PROVIDE THE PERIODS YOU NEED COVERED (EVEN IF YOU ARE OUT ALL DAY!)
*
*DO NOT PUT COVERAGE NEEDED FOR YOUR PREP OR LUNCH PERIODS*
PLEASE PROVIDE THE REASON FOR THE LEAVE/COVERAGE NEED
*
*YOU MAY ENTER "PERSONAL" FOR PERSONAL TIME*
SUBMIT
Should be Empty: