Employee Call Out/ Time Off Request Form
Employee Name
*
First Name
Last Name
Date of Absentee
*
-
Month
-
Day
Year
Date
Date Returning to Work
*
-
Month
-
Day
Year
Date
Reason for Absentee
*
Please Select
Vacation
Personal Leave
Sick
Weather Conditions
Family Emergency
Funeral / Bereavement
Doctors Appointment
Jury Duty
Medical Leave
To Vote
Other
If other, please explain:
If you are missing part of a day, please explain:
Submit
Should be Empty: