Page 56 - New Employee Onboarding
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MISCELLANEOUS TIME OFF REQUEST FORM
Not to be used for Vacation, Personal or Sick Time
Associate Information
Associate Name:
Approving Supervisor:
Dates of Absence: From: / / To: / /
Absence Information
Type of Absence Requested:
Jury Duty * Bereavement Military Time Off Without Pay
* Please attach copy of jury summons.
Reason For Absence:
Total Hours Used:
Jury Duty Military
Bereavement Time Off Without Pay
Associate Signature
Signature: Date:
Supervisor Approval
Approved Rejected Reason Rejected:
Signature: Date:
