Election Leave Request Form
Submit your request for time off to participate in election-related civic duties.
Full Name
*
First Name
Last Name
Employee ID
*
Department
*
Job Title
*
Work Email
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Supervisor/Manager Name
*
Election Date (Leave Date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Leave Duration (hours or days)
*
Brief Explanation of Election-Related Activity
*
Submit Request
Should be Empty: