Paid Sick Time Request – Bilingual Pediatric Therapies

Paid Sick Time Request

Name

First Last

Email

Date

Current or Future Date

Absence is coming up.

Absence has already occurred.

Start Date

End Date

Number of PAID sick hours requested:

Number of scheduled work hours missed/ to be missed:

Number of workdays missed/to be missed:

I would like to take the time off:

Unpaid

*Paid Sick Time eligible only to company employees. 1099 staff not eligible. All 1099 time off will be unpaid.