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Hillsboro Industries Absence Request
Name
(Required)
First
Last
Employee ID
Email
(Required)
Request Type
(Required)
In Late
Out Early
Out and Return
Out of Office
Number of Days (up to 5)
(Required)
One Day
Two Days
Three Days
Four Days
Five Days
Manager
(Required)
Christian Gerken
Jason Elliot
Randy Lewis
Adam Daleiden
Michele O'Hare
Tom Kaufman
Sarah Hill
Select Manager
Absence Date (day 1)
(Required)
MM slash DD slash YYYY
Start Time (day 1)
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Hours of PTO (day 1)
Please enter a number from
0
to
8
.
leave 0 if not using PTO, be sure you are not required to use PTO for the absences prior to submission.
Absence Date (day 2)
(Required)
MM slash DD slash YYYY
Start Time (day 2)
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Hours of PTO (day 2)
Please enter a number from
0
to
8
.
leave 0 if not using PTO, be sure you are not required to use PTO for the absences prior to submission.
Absence Date (day 3)
(Required)
MM slash DD slash YYYY
Start Time (day 3)
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Hours of PTO (day 3)
Please enter a number from
0
to
8
.
leave 0 if not using PTO, be sure you are not required to use PTO for the absences prior to submission.
Absence Date (day 4)
(Required)
MM slash DD slash YYYY
Start Time (day 4)
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Hours of PTO (day 4)
Please enter a number from
0
to
8
.
leave 0 if not using PTO, be sure you are not required to use PTO for the absences prior to submission.
Absence Date (day 5)
(Required)
MM slash DD slash YYYY
Start Time (day 5)
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Hours of PTO (day 5)
Please enter a number from
0
to
8
.
leave 0 if not using PTO, be sure you are not required to use PTO for the absences prior to submission.
Absence Details / Comments
(Required)
NOTE: Comments are visible to all employees with access to the team calendar.
This field is hidden when viewing the form
PTO Hours