Official Request for Time Off

Official Request for Time Off

  • Date Format: MM slash DD slash YYYY
    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.
  • This field is for validation purposes and should be left unchanged.