Absence Request

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Leave of Absence Form

Employee Name

First

Last

Type of Absence Requested: *

Sick

Business Leave

Vacation

Jury Duty

Bereavement

Maternity/Paternity

Time Off Without Pay

OtherOther

Workday Time off Requested? *

Dates of Absence - From *

Dates of Absence End *

Signature *

Today's Date *

Approval

Approved

Denied

Comments

Signature

Date

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