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Request Off

Today's Date (Required)

Time (Required)

010203040506070809101112 00153045 AMPM

First Name (Required)

Last Name (Required)

Department (Required)

Day(s) Requesting Off: (From) (Required)

To (Required)

Reason for Request (Required)

By checking this box, I understand that this is a request form only and does not guarantee the requested time will be granted. I Understand.

Employee's Full Name (Required)