Time Away From Work Request

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TIME AWAY FROM WORK REQUEST
TIME AWAY FROM WORK REQUEST
DEPARTMENT:
DEPARTMENT:
Today’s Date___________________________________________
Today’s Date___________________________________________
Name_________________________________________________
Name_________________________________________________
I hereby request the following day(s) as time-away
I hereby request the following day(s) as time-away
for the calendar year
for the calendar year
Dates
# of Days
Dates
# of Days
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
Emergency Contact Phone Number_________________________
Emergency Contact Phone Number_________________________
Please check the appropriate box below:
Please check the appropriate box below:
Vacation
Funeral
Jury Duty
Vacation
Funeral
Jury Duty
Other
Other
I will be off-campus the following day(s) for a
I will be off-campus the following day(s) for a
conference/training time/etc.
conference/training time/etc.
Dates
# of Days
Dates
# of Days
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
___________ through ___________
______________
Name of Conference/Training
Name of Conference/Training
Location of conference/training____________________________
Location of conference/training____________________________
Emergency Contact Phone Number_________________________
Emergency Contact Phone Number_________________________
Employee Signature_____________________________________
Employee Signature_____________________________________
Supervisor Signature________________________Date_________
Supervisor Signature________________________Date_________

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