Employee Name

First Name

Last Name

Type of Absence Requested

Sick

Vacation

Floating Holiday

Time Off With No Pay

Other

Dates of Absence

Number of Business Days

Number of Sundays

Hours

Reason for Absence

Except for sick leave, if possible, please submit this form at least two weeks prior to the first day you will be absent.

Employee Signature

Date

YYYY

Absence Request

New Life Church