Time Off Request Employee Name*FirstLast Employee Number Type of Occurrence* Paid Time OffScheduled Time Off (Unpaid) Date of Occurrence* Reason for Occurrence*Employee IllnessDeath in FamilyFamily IllnessFMLAJury DutyLeave of AbsenceMedical AppointmentMilitary LeavePersonalRefused Light DutyOther (Please Specify) Notes Email*SubmitReset
