Public Utility Planning Leave Time-Off Form
Please fill out this form to request leave or time-off for public utility planning purposes.
Full Name
First Name
Last Name
Employee ID
Department
Please Select
Planning
Operations
Maintenance
Customer Service
Administration
Type of Leave Requested
Vacation Leave
Sick Leave
Emergency Leave
Bereavement Leave
Other
Start Date of Leave
-
Month
-
Day
Year
Date
End Date of Leave
-
Month
-
Day
Year
Date
Reason for Leave
Contact Number During Leave
Please enter a valid phone number.
Submit
Should be Empty: