Unpaid Time Off Request
Submit your request for unpaid time off. All requests will be reviewed by your manager or HR.
Full Name
*
First Name
Last Name
Employee ID
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Store Location / Department
*
Job Title
*
Type of Leave Requested
*
Personal Leave
Family Emergency
Medical Reason
Other
Start Date of Unpaid Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date of Unpaid Leave
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Total Number of Days Requested
*
Reason for Unpaid Leave
*
Supervisor/Manager Name
*
Additional Comments or Information (optional)
I acknowledge that this request is for unpaid time off and understand the impact on my compensation.
*
I understand and agree
Submit Request
Should be Empty: