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This is a form that should be completed no later than 45 days PRIOR to whatever time off is requested. Please note that no time off requested will be permitted if more than one employee is off for that specific date requested.
Should you have questions about time off, please refer to your employee handbook that can be located on the Google Drive. You will receive a response about your time off request within 5 business days.
What is your name? (First Name, Last Name)
What date(s) off would you like to request? You may provide a reason if you'd like.

Time Off Request Medical Form

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