Official Request for Time Off Official Request for Time Off All time off requests must be submitted two weeks in advance for approvalDate:* MM slash DD slash YYYY Employee Name:* Reason for Time Off* Date Requested Off From / To: Is this Paid Time Off? Yes No Is this a FMLA (Family Leave of Absense) Request: Yes No All medical appointments must be submitted with a return to work doctor’s / dentist excuse. No faxes or telephone calls will be accepted. The medical excuse must be turned in on the day you will be returning to work. If you forget the excuse, the absence will be considered un-excused.EmailThis field is for validation purposes and should be left unchanged. Δ
