Paid Time Off Request for Time Off
Absence Request
Absence Information
Today's Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Name:
*
First Name
Last Name
Las 4 of SSN:
*
Phone Number:
*
Format: (000) 000-0000.
Job Location:
*
Supervisor Name:
*
First Name
Last Name
Type of Absence Requested:
*
Sick
Vacation / PTO
Bereavement
Time Off Without Pay
Military
Jury Duty
Maternity/Paternity
Other
Dates of Absence: From:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Absence:
*
You must submit requests for absences, other than sick leave, two days prior to the first day you will be absent.
If less than a full day, what time will you be leaving and what time will you return.
For questions regarding this form please refer to your new employee handbook or contact your TruTEMPS representative at 915-275-2665
Employee Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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