Employee Leave Request
Date and Time This Request Was Submitted
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Your Name
*
First Name
Last Name
Employee email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Desired Time Off
*
-
Month
-
Day
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Explanation
*
When Will You Return To Work?
*
-
Month
-
Day
Year
Date
Reason for Request
*
Vacation
Personal Leave
Bereavement
Jury Duty
Medical Leave
Other
I understand this is a request only and must be approved by my employer 14 days in advance. Also, the amount of time off is based off the amount time you've incurred over your employment at Halo Med Spa.
*
I understand
Employee Signature
Submit
For Management Use
Approved
Rejected
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