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Vacation and Leave Requests Page
Employee Intranet
Feedback Form
Vacation and Leave Requests
FMLA Employee Requests
Vacation / Leave Request Form
Please provide as much notice as possible, and coordinate with your manager and pod mates.
Date of Request:
MM slash DD slash YYYY
Employee Name:
Employee email (to receive confirmation of request)
Vacation Time Start Date
MM slash DD slash YYYY
Vacation End Date
MM slash DD slash YYYY
Total Hours:
Bereavement Leave Start
MM slash DD slash YYYY
Bereavement leave (Up to three days of paid leave due to a death in the immediate family is available.)
Bereavement Leave End
MM slash DD slash YYYY
Total Hours:
Other Leave (Insert the leave policy name below)
This form should not be used to request leave under the Family and Medical Leave Act (FMLA) or to request leave as an accommodation under the Americans with Disabilities Act (ADA). Employees should consult with HR to request leave under the FMLA or ADA and request time using the FMLA form on the employee intranet.
Other Leave Start
MM slash DD slash YYYY
Other Leave End Date
MM slash DD slash YYYY
Total Hours: