Name:                                                

Sick Leave:            Full Day       Will be In Later - Time:

The following times are requested for time off:    through  

I would like the following times used:

Hours Vacation:                

Hours Sick Leave:   

Personal Holiday:              

Hours C.T.O.:           

I understand that all requests are subject to change and/or cancellation at any time and that requests are granted on a first-in basis. Docks will be applied against wages if sufficient leave credits are not available for the time off requested.