Leave Request Form Date of Request MM slash DD slash YYYY Date you are putting in your request for time off to Administration.Time of Request Hours : Minutes AM PM AM/PM Time you are putting in your request for time off to Administration.Name of Person Requesting Leave(Required) First Last * Please note, a leave request does not guarantee time off. All leave requests must be approved by Administration.Email of Person Requesting Leave(Required) Enter Email Confirm Email Reason for RequestPlease choose best option for your leave request.Reason for Leave Sick- Self Sick- Family Sick- Other Other Bereavement Civil Duty Maternity Leave Vacation Funeral Other Reason Defined Time of RequestHours requested if not a full day requesting time offTime Starting Hours : Minutes AM PM AM/PM Time Returning Hours : Minutes AM PM AM/PM Dates of RequestDate From MM slash DD slash YYYY Date To MM slash DD slash YYYY Δ
