Absence Request

An employee is expected to submit in writing requests for days off two weeks prior to the requested days off.

* Indicates required field

Employee Name *

First

Last

Email *

Phone Number *

Immediate Supervisor *

First

Last

Beginning Date of Absence *

Date to Return to Work *

Reason for Absence: *

Are you requesting these days be considered for vacation pay (if available) reimbursement? *

You must submit requests for absences, other than sick leave, two weeks prior to the first day you will be absent to allow for appropriate approval. We are unable to approve all requests for absences given individual job requirements. By pressing submit below, you are signing this request as your own and you are acknowledging that this is a request and you understand the absence is not yet approved.

Submit

Frequent absences, such as two unapproved sick/personal days within a month period, will be evaluated for termination of position.