Employee Time Off Form

Please fill out the form and submit. We will notify you that your request has been processed and either approved or denied.
  • Please add notes here. Need a later start time? Early day? Need a specific block of time off for an appointment, etc?
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
    For a single day off, the first and last day of leave will be the same date. So for new years day off, both entries would be 01/01/19.
  • Date Format: MM slash DD slash YYYY
    The first day you will return to work after your time off.