Time Off Request
Name
First Name
Last Name
Date Submitted
Dates Requested:
Total Number of Days:
Reason for Absence:
Vacation
Personal Day
Illness
Doctor Appointment
Condolence/Bereavement
How Long Will You Be Gone?
All Day
Morning Only (8:30-1:00)
Afternoon Only (1:00-5:30)
Other - It's Complicated
Does your immediate supervisor know of this absence?
Yes
No
Would you like to know how many days you have remaining?
Yes
No
General Explanation for Absence:
Submit
Should be Empty: