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* 1. Your Name

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* 2. Please fill in the dates you would like off. Just put the day in numbers. For example for Wed, February 2, 2026, you would just put 2 in the February 2026 box. Thanks.

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* 3. Is there any other info you would like me to know? (For example, you can work another day in exchange for taking the day off. Perhaps you want to cancel a previously requested date).

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