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Time Off Request
Please submit the times you need to take off work and the type of leave you are taking.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Starting Date & Time
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Ending Date & Time
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Type of Leave
*
Vacation
Personal
Sick Leave
Bereavement
Jury Duty
Military
Other:
Total Hours of Leave Requested
Your answer
Description (optional)
Your answer
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