FMLA / Personal Request

Use this form to request time off.

It will then be sent to HR.

Your Name [Required]

Your Phone Number [Required]

Your Email

Type of Request [Required] —Please choose an option—FMLAPersonal LeaveMedical Leave

Reason for Request [Required]

Expected Leave Date (first date you will be absent from work) [Required]

Expected Return Date (date you plan on returning back) [Required]

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