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.

"*" indicates required fields

Name of Employee*

Email*

Your Supervisor*

Absent From (mm/dd/yyyy)*

Through (mm/dd/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

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