Disciplinary Process Time-Off Form
Please complete this form to request time off related to disciplinary processes.
Employee Full Name
First Name
Last Name
Employee ID
Department
Please Select
Human Resources
Finance
Marketing
Sales
Operations
IT
Customer Service
Other
Supervisor/Manager Name
First Name
Last Name
Date of Request
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Date of Time-Off
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date of Time-Off
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Time-Off
Have you received prior disciplinary action related to this time-off request?
Yes
No
Additional Comments
Submit
Should be Empty: