Time Off Request

Name

First Name

Last Name

Type of Time Off *

Days

Hours

Start Date *

MM

DD

YYYY

End Date *

MM

DD

YYYY

Start Time

Hour

Minute

Second

AM PM

End Time

Hour

Minute

Second

AM PM

Reason for Time Off *

Vacation

Personal Leave

Medical Leave

Family Reasons

To Vote

Jury Duty

Funeral/Bereavement