The employee MUST complete, sign and submit this ‘Sick Time Off Request’ form in order to be paid for sick leave.

Additionally, YOU MUST CALL YOUR DIRECT SUPERVISOR & YOUR FOOTBRIDGE RECRUITER to provide notice of your time off.

"*" indicates required fields

I attest that I used earned sick time for the authorized reason(s) checked below:*

Please provide the dates of your time off

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Signature

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