FCCS Time Off Request
Requests for Vacation must be submitted two weeks in advance of the first day of absence. PTO days must be submitted 2 weeks prior to the first day of absence. By completing this form and signing below, you understand that this submission for time off is only a request and does not guarantee approval. You will be notified of your approval status by your manager.
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Email *
 Employee Name: *
Phone Number: *
Program: *
 Supervisor: *
Type of Absence Requested: *
Absence START: *
MM
/
DD
/
YYYY
Absence END:  *
MM
/
DD
/
YYYY
Total  Days Off: *
 Comments/Reasons:
Signature (Initials): *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Four Corners Community Services.