; Employee absence request form
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Employee absence request form

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									Company Name
Absence Request
Absence Information
Employee Name: Employee Number: Manager: Type of Absence Requested: Sick Military Dates of Absence: From: Reason for Absence: Vacation Jury Duty Bereavement Maternity/Paternity To: Time Off Without Pay Other Department:

You must submit requests for absences, other than sick leave, two days prior to the first day you will be absent.

Employee Signature


Manager Approval
Approved Rejected Comments:

Manager Signature


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