Extended Day Staff Time off Request - ONLINE

 
1.

Employee Name:

 
 
2.

Date Submitted (Today's Date):

 
 
3.

Position (please check one):

 
 
4.

Date(s) of Absence:

 
 
5.

Location:

 
 
6.

Time of Shift(s):

 
 
7.

Number of Hours:

 
 
8.

Reason for Absence:

 
 
9.

Do you have any flexibility with this request if we are unable to approve it (can you change to another day or time)?

 
 
10.

Phone Number you can be reached at if we need to discuss the request with you:

 
 
11.

Additional Information:

 
 
 

Click on submit below and your notification will automatically be sent to Carla Laurent.