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*
Time off requested
Choose 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*
Employee Signature
First Last
Signature
- Please select this box to sign