First Name *

Last Name *

Email *

Phone *

Time-off Request *

Please enter the total number of hours or days you'd like to request.

Are you requesting hours or days off?

Hour(s)

Day(s)

Time-off Beginning On: *

Time-off Ending On: *

Reason for Time-off Request *

Vacation
Personal Leave
Birthday
Funeral / Bereavement
Jury Duty
Family Reasons
Medical Leave
To Vote
Other
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If other, please explain

I understand that this request is subject to approval by my employer