Time Off request (scheduled in advance)

Employee Name*

Select

Leave Type*

Sick Self

Sick Family

Vacation

CTO

Personal Holiday

Bereavement

Jury Duty (documentation required)

Subpoenaed Witness (documentation required)

Military Leave

Parental Leave

DOCK

ADO

Is this request related to an authorized FMLA Leave?*

Yes

No

Partial Day?*

Yes

No

Begin Date*

End Date*

Hours Used*

By submitting this form, I acknowledge that I have sufficient leave balances for the type of leave requested above.

If I am unsure of whether or not I have sufficient leave balances, I have reviewed my leave balances with my appropriate administrator to ensure that I have sufficient leave balances for the type of leave requested.

Send me a copy of my responses