Duty Exemption Request Form
Submit your request for exemption from assigned duties. Please provide complete and accurate information to ensure timely processing.
Applicant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Unit
*
Position or Role
*
Type of Duty for Which Exemption is Requested
*
Please Select
Regular Shift
Special Assignment
Overtime Duty
On-call Duty
Other
Duty Date(s) or Period
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Exemption Request
*
Please upload any supporting documents (e.g., medical certificate, official letter)
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Supervisor or Department Head Name
*
Supervisor or Department Head Email
*
example@example.com
Submit Request
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