Time Off Request (Ultimate Print Source)
Please submit the dates you wish to take off work and the type of leave you are requesting.
Email address *
Today's Date *
MM
/
DD
/
YYYY
Your Name *
Your answer
Your Title
Your answer
Your Department
Your answer
1st Day of Requested Leave? *
MM
/
DD
/
YYYY
Date Returning to Work?
MM
/
DD
/
YYYY
Number of Days Paid?
Type of Leave? *
Description if needed. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum.
Reason for leave: (If in addition to information above)
Your answer
A copy of your responses will be emailed to the address you provided.
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