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Personal Time Off Request

Complete this form to request personal or discretionary time off. Your request will be forwarded to Mr. Boole. If there is a problem with your request, you will be notified in writing.

Employee Name*

Answer required for "Employee Name"

I am requesting the following date(s) for personal leave*

Answer required for "I am requesting the following date(s) for personal leave"

Please indicate the reason for your leave request below (optional)

Answer required for "Please indicate the reason for your leave request below (optional)"

Indicate below if you want personal or discretionary time off.*

Answer required for "Indicate below if you want personal or discretionary time off."

Which substitute do you want contacted? (if available)*

Answer required for "Which substitute do you want contacted? (if available)"

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"