Instructions: • For 1 day off, pick one date in the "From Date". • For more than 1 day off, enter the first day of your time off in the From Date and the last day of your time off in the To Date. • If you are arriving or leaving early on a certain day, please enter the From Date and Time In/Out. Name (First/Last): * Email Address: * From Date: To Date: If arriving late or leaving early: Time In (if coming in late): Time Out (if leaving early): Date You Will Return to Work: Reason for Request: