Homak Intake
Absence Request
Store 34994
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attached.
Employee name *
Date *
Request type *
Select…
I shall be absent (future)
I have been absent (past)
Absence date(s) — start *
Absence date(s) — end
Number of days
Number of hours
Reason for absence *
Sick Leave - Self
Sick Leave - Family Member
Sick Leave - Designated Person
Vacation / PTO
Jury Duty (attach summons)
School/child care activity or emergency (attach documentation)
Bereavement (attach documentation per company policy)
Reproductive Loss Leave
Other
Employee believes this absence may qualify for FMLA or CFRA leave
Select…
Yes
No
Name of designated person (if applicable)
Relationship to deceased (if bereavement)
If "Other," please explain
Submit
