Absence Request Form - Diamond Healthcare Staffing

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Absence Request Form
Notification of time off is needed two weeks prior of your anticipated absence.
Date:
Employee Name:
Start Date
End Date
PTO Hours Requested
Employee Comments:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Employee Signature:
Date:
OFFICE USE ONLY
[
] Approved
[
] Not Approved
Date:
Comments:
Manager Signature:
Date:
EMPLOYEE ABSENCE REQUEST FORM

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