Absence Request Form


  Name:                                         Date:                            

  Department:                                               
 
  Requested No. of Scheduled Work Day(s) Off:                             

  On/Beginning:        /       /         through         /       /       

  Comments:                                                                                                    
        
                                                                                                                     
        
                                                                                                                     
        




  Absence to be taken as:

                                          Hours

      þ Paid Time Off                                  
      þ Unpaid Time Off                                
      þ Other (Explain Below)                          
  
                                Total                  

  Comments:                                                                                                    
        
                                                                                                                     
        
                                                                                                                     
        




  Approved By:

  Department Manager:                                Date:                           

  Additional:                                        Date:                           





     
     SP01 (Rev. 2/92)