Leave Request Form Leave Request Form Name(Required) First Last Email(Required) FMLA-Qualifying Event No Yes For partial days, or a combination of leave types, please provide details in the additional comments below.Type of Leave(Required) Vacation Sick Other Leave Begin Date(Required) MM slash DD slash YYYY Begin Time(Required) Hours : Minutes AM PM AM/PM Return-to-Work Date(Required) MM slash DD slash YYYY Return-to-Work Time Hours : Minutes AM PM AM/PM Total Hours Requested(Required)Please round to the closest .25, .50, .75, or whole hour increment as appropriate.Additional Comments
