Employee Time-Off Request Form | HCSW

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Tel: 757-525-4812

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Employee Time-Off Request Form

Time-Off Request Form

First Name

Last Name

Today's Date

How many days are you requesting off?

Beginning date:

Ending date:

Reason for leave:

I understand that this request is subject to employer's approval (electronically sign below)

Print Name:

Date

Recieved, thanks for submitting!

Hummingbird Counseling Services for Women

Email: info@hummingbirdforwomen.com
Tel: 757-525-4812
813 Forrest Dr., Suite A

Newport News, VA 23606

Therapist Hours

Monday - Friday, 10:00am - 6:00pm

Saturdays, 10am - 2pm
By Appointment Only

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Contact Us

First Name

Last Name

Phone

Email

Your Message

We will contact you soon!

Home
Get Started
Therapists
Services
- Substance Abuse Treatment
- Outpatient Therapy
Policy
Forms
Rates
Pay Online
- Pay for Groups
- No Show/Late Cancel Payment
Sign Up
No Surprise Act
Contact Us
More...

Use tab to navigate through the menu items.

2020 by Hummingbird Counseling Services for Women

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