Absence Request Form

* Indicates required field

Employee Name: *

First

Last

4 Digit Employee Number *

Phone Number *

Email *

Manager: *

Type of Absence Requested *

Dates of Absence Requested

From: *

Date of Return: *

Reason for Absence Requested: *

All absence requests require 30 days notice and must be approved by a supervisor upon submission. Please call our office if you need to call off sick.

Submit

Vacation Time?

Absence Request Form

Dates of Absence Requested