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This form should be completed and submitted to your manager at least 2 weeks prior to your requested time off.
If Requesting partial day - Please indicate: AM __________ or PM __________ Time off should be recorded as: Vacation Sick Total Hrs Total Hrs
Date
Manager
Date
Date
Administration Use Only: Date added to Vacation Calendar Remaining paid Hours available: Previously scheduled dates: Also requesting these dates: Time Off if approved will be: Paid Unpaid By: As of: Total Hrs Total Hrs By:
Additional Notes: