PTO / Sick Request

If you are requesting time off due to the COVID-19, please review the FFCRA document below:

If you are human, leave this field blank.

PERSONAL TIME-OFF REQUEST FORM

Your Full Name *

Today's Date *

Email Address *

Dates request off

Please submit request at least 2 weeks prior to the desired dates. Requests submitted with less than 2 weeks lead time are unlikely to get approved.

Option 1

From *

To *

Returning back to work on *

Option 2

From

To

Returning back to work on

Reason for time off *

Sick

Medical Appointment

Jury Duty

Personal Reasons

Family Reasons

Vacation

Other

Notes

Paid Leave? *

Paid LeaveUnpaid LeaveIf you have paid leave days, but prefer not using them, select "Unpaid leave"

Attention! Submitting this form does not guarantee time off. You will receive an email from HR if approved.

Submit