Sellin Brothers 75th Anniversary | Sellin Brothers Inc.

Time Off Request

Name
First Last
Start Date:*
MM slash DD slash YYYY
End Date:*
MM slash DD slash YYYY
Start Time

: Hours

Minutes

AM/PM
End Time

: Hours

Minutes

AM/PM
Total Hours*
Reason for Leave*

Please indicate the reason for the request. A reason is not required but strongly recommended. The reason for leave will be used to determine approval or denial.
Reason for Leave:*
- Personal Leave
- Jury Duty
- Funeral Leave
- FMLA Leave
- Military Leave
- Parenting Leave
- Other
Relation if Funeral Leave:
HR Signature

To be completed by HR Department. Do not fill in.
Employee Signature*