Request Time Off

UAPD Absence Report

This is the official record of all time off from work. Please complete the form carefully. Vacation, Leaves of Absence, Jury Duty, and Professional Days must be approved in advance.

Name of Employee*
Email*
Your Supervisor*
Absent From (mm/dd/yyyy)*
MM slash DD slash YYYY
Through (mm/dd/yyyy)*
MM slash DD slash YYYY

NOTE: Do not include date returning to work
Total Number of Days Off
OR, Total Number of Hours Off
Reason for Absence
- Vacation*
- Scheduled Sick* (e.g. doctor appointment) (self)
- Scheduled Sick* (e.g. doctor appointment) (family)
- Sick (self)
- Sick (family)
- Professional Day*
- Jury Duty*
- Leave of Absence*
- Other*
* Must be approved in advance
If requesting a Professional Day, list date(s) worked:
Comments

Request Time Off

UAPD Absence Report

ADDRESS

PHONE

Email