Time-off Request Form
* Vacation & Other request are subject upon approval.
Your Name
*
First Name
Last Name
E-mail
*
Cellphone Number
*
-
Area Code
Phone Number
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Type of Leave:
*
Vacation
Sick
Others (without pay)
Additional Comments
*
* Reason for leave/name of staff working for you
Attached Doctor's Note: (Sick Leave)
Browse Files
Cancel
of
Signature
*
Submit Form
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