Leave Request
Form to request leave of absence
.
PAID TIME OFF requests to be done 4 days in advance
Sick / Emergency time off  request to be done 1 day in advance
Unpaid Time Off requests to be done 1 day in advance.

In the event of no show without requests, days will be counted as unpaid.
Email *
Name *
Reason for Leave *
Start Date *
MM
/
DD
/
YYYY
End Date *
MM
/
DD
/
YYYY
Able to work remotely *
Type of Leave *
Estimated Paid Time off Days
Include  working days. Do not add the Saturday and Sunday weekends.
Estimated Unpaid Time off (UTO)
Include  working days. Do not add the Saturday and Sunday weekends.
Other Comments
A copy of your responses will be emailed to .
Submit
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