ABBREVIATED LEAVE FORM
Employee Name
*
Employee Email
*
example@example.com
Request Date
/
Month
/
Day
Year
Date
Reason for Request
*
Time & Date to Arrive Late/Leave Early(before 8:30 AM or after 2:00 PM ONLY)
Late/Early
Arrive Late
Leave Early
Late/Early Date
*
/
Month
/
Day
Year
Date
Late/Early Time
*
Hour Minutes
AM
PM
AM/PM Option
Time & Date absence will be made up (within 5 working days of absence)
Time & Date absence will be made up (within 5 working days of absence)
*
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Employee Signature
*
Date
/
Month
/
Day
Year
Date
For Administrative Use Only
Request Approved
Request Denied
Administrator Signature
Date
/
Month
/
Day
Year
Date
Submit
Should be Empty: