Time Off Request Form
Today's Date:
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Month
-
Day
Year
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Employee Name:
*
Please Select
Allen Carmichael
Amanda Moutinho
Angela Evans
Caitlin Rocket
Cal Winn
Dave Hasson
Dave Kirby
Devin Edgley
Fran Zankowski
Jason Myers
Joel Dyer
Julian Bourke
Kellie Robinson
Mark Goodman
Sue France
Email Address:
*
Start Date:
*
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Month
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Day
Year
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:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
End Date:
*
-
Month
-
Day
Year
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1
2
3
4
5
6
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9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Total Hours:
*
PAID or UNPAID:
*
Paid
Unpaid
Not Sure
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