Request for Day(s) Off

Absence Information
Employee Name:
Employee Number:			Department:
Manager:
Type of Absence Requested:
	Sick	Vacation		Bereavement				Time Off Without Pay
	Military	Jury Duty		Maternity/Paternity				Other
Dates of Absence: From:					To:
Reason for Absence:
You must submit requests for absences, other than sick leave, Five(5) days prior to the first day you will be absent.
Employee Signature						Date
Manager Approval
	Approved
	Rejected
Comments:
Manager Signature							Date