Absence Request

Employee Absence Form

“Planned” absence “MUST” be submitted TWO WEEKS in advance for approval. Unplanned must also be submitted for record keeping purposes.

Today's Date

Employee's Full Name

Employee's Job Site(s)/Location(s):

Dates of Absense:

First Date of Absence:

Date to Return back to Work:

Type of Absence: (for consideration purposes)

Check all that apply:

Bereavement (Provide name, relationship, date of decease, date of services and funeral home, in comment field) Surgical Procedures Jury Duty Maternity/Paternity Leave of Absence Vacation Sick Day(s) Family sickness/emergency Medical/Dentail Appointment Other (Please provide details.)

Additional Details:

Please ensure you receive a "successful submitted" statement upon submitting your request. You will be contacted with regards to this request.

Absence Request

Employee Absence Form

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