REQUEST FOR VACATION DAYS
TODAYS DATE
*
-
Month
-
Day
Year
Date
STORE:
*
MI053 - Lake Orion
MI054 -Novi
MI055 - South Lyon
MI062 - Novi
MI063- Oxford
MI083 - Milford
MI117 - Jackson
Name
*
First Name
Last Name
# OF DAYS REQUESTING
*
1
2
3
4
5
6
7
8
9
10
Vacation/Sick Day
Please Select
Vacation
Sick
DATES REQUESTING OFF
*
-
Month
-
Day
Year
Date
THRU (IF MORE THAN ONE)
-
Month
-
Day
Year
Date
Comments
Submit
OFFICE USE ONLY
Should be Empty: