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Time off request
Please submit the times you need to take off work and the type of leave you are taking.
Email address *
Name *
Your answer
Requested date(s) *
Your answer
Please select which day(s) *
Required
AM/PM/All day *
Are you requesting paid time off for the date(s) above. *
Todays Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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