Employee Name
Please Select
Amy Screws
Chad McDaniel
Chasity Ray
Dana Hutchison
Keith Geter
Missy Allen
Type of Leave Requesting
*
Please Select
Sick
Vacation
Unpaid
Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How many hours of leave (if not whole day)
*
Please Select
1
2
3
4
5
6
7
Whole Day or More
Any request for more than 14 consecutive work days requires a verbal request to the Executive Director.
How many days of leave (if more than a whole day)
*
Please Select
Less than one day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Any request for more than 14 consecutive work days requires a verbal request to the Executive Director.
Employee Email
example@example.com
Manager Email
example@example.com
Submit Leave Request
Should be Empty: