Absence Notification

Absence Request Form

Employee Name*

First Name

Last Name

Job Title*

Supervisor*

First Name

Last Name

Department*

First Day of Absence*

Last Day of Absence*

Reason for Request

Vacation Personal Paid Time (PPT) Bereavement

Other:

If selecting BEREAVEMENT, note the deceased's name and relationship in the Comments section.

Comments*

Employee's E-mail Address

Confirm Employee's E-mail Address *

Supervisor's E-mail Address*

Confirm Supervisor's E-mail Address *

Double check the spelling of email address, or it won't go to the right person