Paid Time Off Request You will use this form to request paid sick leave. Date Requested* MM slash DD slash YYYY Employee Identification* First Last TC# Email Store*Choose your store17885 - Colfax32702 - Florin47 - Fruitridge33506 - Galleria Mall (Roseville)13923 - Lincoln31795 - Lincoln (2)36256 - Reno32133 - Rocklin3286 - Sparks17834 - Stanford Ranch6832 - Truckee30288 - Walmart (Roseville)1051 - Chico5354 - Chico12390 - Chico37011 - Chico39626 - Orland, CaTime off requestedChoose One*Select one option to continue Sick Leave From* MM slash DD slash YYYY To* MM slash DD slash YYYY Total Paid Sick Leave Hours Requested*Hours Requested123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960Employee Signature First Last Signature Please select this box to sign