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Example Time-Off Request
Please submit the times you need to take off work and the type of leave you are taking.
Approval will be sought from your Line Manager.
Note, this template is a sample only of what a Time-Off Request Form may look it. It is not a functional form.
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* Indicates required question
Full Name
Your answer
Department
Finance
Human Resources
IT
Marketing
Operations
Clear selection
From
*
First day of leave
MM
/
DD
/
YYYY
To
*
Last day of leave
MM
/
DD
/
YYYY
Number of days
Your answer
Leave type
*
Choose
Sick leave (Illness or Injury)
Bereavement leave
Recreational leave
Leave without pay
Line Manager
*
Email address
Your answer
Submit
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