Time Off Request Form < Go Back to Portal Employee Name * First Name Last Name Email * Time Off Starting On * MM DD YYYY Returning to Work On * MM DD YYYY Total Number of Days Off Type of Absense * Paid Unpaid Purpose * Vacation Sick Personal Leave Funeral/Bereavement Jury Duty Family or Medical Leave Other Other Notes Any additional details Employee Signature * I agree that by clicking and submitting this form, I am providing my digital signature and that the information is accurate to the best of my knowledge. I Agree Your request has been submitted. Please reach out to your supervisor if you do not get a response within 48 hours.
