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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd">
<html class="supernova"><head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<link rel="alternate" type="application/json+oembed" href="https://www.jotform.com/oembed/?format=json&url=https%3A%2F%2Fform.jotform.com%2F201034088418450" title="oEmbed Form">
<link rel="alternate" type="text/xml+oembed" href="https://www.jotform.com/oembed/?format=xml&url=https%3A%2F%2Fform.jotform.com%2F201034088418450" title="oEmbed Form">
<meta property="og:title" content="Leave Request Form" >
<meta property="og:url" content="https://form.jotform.com/201034088418450" >
<meta property="og:description" content="Please click the link to complete this form.">
<meta name="slack-app-id" content="AHNMASS8M">
<link rel="shortcut icon" href="https://cdn.jotfor.ms/favicon.ico">
<link rel="canonical" href="https://form.jotform.com/201034088418450" />
<meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1" />
<meta name="HandheldFriendly" content="true" />
<title>Leave Request Form</title>
<link href="https://cdn.jotfor.ms/static/formCss.css?3.3.16943" rel="stylesheet" type="text/css" />
<link type="text/css" media="print" rel="stylesheet" href="https://cdn.jotfor.ms/css/printForm.css?3.3.16943" />
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/nova.css?3.3.16943" />
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/themes/CSS/566a91c2977cdfcd478b4567.css?themeRevisionID=5dca5ac9a5e86d17235d90c1"/>
<style type="text/css">
.form-label-left{
width:150px;
}
.form-line{
padding-top:12px;
padding-bottom:12px;
}
.form-label-right{
width:150px;
}
body, html{
margin:0;
padding:0;
background:#F9F2E7;
}
.form-all{
margin:0px auto;
padding-top:0px;
width:690px;
color:#3E4E1A !important;
font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif;
font-size:14px;
}
.form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{
color: false;
}
</style>
<style type="text/css" id="form-designer-style">
/* Injected CSS Code */
/*PREFERENCES STYLE*/
.form-all {
font-family: 'Lucida Grande', 'Lucida Sans Unicode', 'Lucida Sans', Verdana, Tahoma, sans-serif, sans-serif;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-family: 'Lucida Grande', 'Lucida Sans Unicode', 'Lucida Sans', Verdana, Tahoma, sans-serif, sans-serif;
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-family: 'Lucida Grande', 'Lucida Sans Unicode', 'Lucida Sans', Verdana, Tahoma, sans-serif, sans-serif;
}
.form-header-group {
font-family: 'Lucida Grande', 'Lucida Sans Unicode', 'Lucida Sans', Verdana, Tahoma, sans-serif, sans-serif;
}
.form-label {
font-family: 'Lucida Grande', 'Lucida Sans Unicode', 'Lucida Sans', Verdana, Tahoma, sans-serif, sans-serif;
}
.form-label.form-label-auto {
display: block;
float: none;
text-align: left;
width: 100%;
}
.form-line {
margin-top: 12px 36px 12px 36px px;
margin-bottom: 12px 36px 12px 36px px;
}
.form-all {
width: 590px;
}
.form-label.form-label-left,
.form-label.form-label-right,
.form-label.form-label-left.form-label-auto,
.form-label.form-label-right.form-label-auto {
width: 150px;
}
.form-all {
font-size: 14pxpx
}
.form-all .qq-upload-button,
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-size: 14pxpx
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-size: 14pxpx
}
.supernova {
background-color: #8FBDFD;
}
.supernova body {
background: transparent;
}
.supernova .form-all, .form-all {
background-color: #F9F2E7;
border: 1px solid transparent;
}
.form-all {
color: #3E4E1A;
}
.form-header-group .form-header {
color: #3E4E1A;
}
.form-header-group .form-subHeader {
color: #3E4E1A;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html,
.form-checkbox-item label,
.form-radio-item label {
color: #3E4E1A;
}
.form-sub-label {
color: #586834;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: #fff;
}
.form-line-error {
overflow: hidden;
transition: none;
background-color: #FFF4F4;
}
.form-line-error .form-error-message {
background-color: #FF3200;
clear: both;
float: none;
}
.form-line-error .form-error-arrow {
border-bottom-color: #FF3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
border: 1px solid #FF3200;
.box-shadow(0 0 3px #FF3200);
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
.form-all {
background-image: none;
}
.ie-8 .form-all:before { display: none; }
.ie-8 {
margin-top: auto;
margin-top: initial;
}
/*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/
/* Injected CSS Code */
</style>
<script src="https://cdn.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script>
<script src="https://cdn.jotfor.ms/static/jotform.forms.js?3.3.16943" type="text/javascript"></script>
<script type="text/javascript">
JotForm.init(function(){
setTimeout(function() {
$('input_7').hint('ex: 12345678');
}, 20);
if (window.JotForm && JotForm.accessible) $('input_4').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_5').setAttribute('tabindex',0);
JotForm.calendarMonths = ["January","February","March","April","May","June","July","August","September","October","November","December"];
JotForm.calendarDays = ["Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"];
JotForm.calendarOther = {"today":"Today"};
var languageOptions = document.querySelectorAll('#langList li');
for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) {
languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar("10", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }, 0); });
}
JotForm.setCalendar("10", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""});
JotForm.formatDate({date:(new Date()), dateField:$("id_"+10)});
JotForm.displayLocalTime("hour_10", "min_10", "ampm_10");
JotForm.calendarMonths = ["January","February","March","April","May","June","July","August","September","October","November","December"];
JotForm.calendarDays = ["Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"];
JotForm.calendarOther = {"today":"Today"};
var languageOptions = document.querySelectorAll('#langList li');
for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) {
languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar("11", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }, 0); });
}
JotForm.setCalendar("11", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""});
JotForm.formatDate({date:(new Date()), dateField:$("id_"+11)});
JotForm.displayLocalTime("hour_11", "min_11", "ampm_11");
if (window.JotForm && JotForm.accessible) $('input_12').setAttribute('tabindex',0);
JotForm.newDefaultTheme = false;
/*INIT-END*/
});
JotForm.prepareCalculationsOnTheFly([null,{"name":"clickTo","qid":"1","text":"Request for Leave","type":"control_head"},{"name":"submit","qid":"2","text":"Request Leave","type":"control_button"},{"name":"name","qid":"3","text":"Name","type":"control_fullname"},{"name":"position","qid":"4","text":"Position","type":"control_textbox"},{"name":"manager","qid":"5","text":"Manager","type":"control_textbox"},{"name":"phoneNumber6","qid":"6","text":"Phone Number","type":"control_phone"},{"name":"employeeId","qid":"7","subLabel":"8 digit employee ID","text":"Employee ID","type":"control_number"},{"name":"clickTo8","qid":"8","text":"Details of Leave","type":"control_head"},{"name":"leaveType","qid":"9","text":"Leave Type","type":"control_radio"},{"name":"leaveStart","qid":"10","text":"Leave Start","type":"control_datetime"},{"name":"leaveEnd","qid":"11","text":"Leave End","type":"control_datetime"},{"name":"comments","qid":"12","text":"Comments","type":"control_textarea"}]);
setTimeout(function() {
JotForm.paymentExtrasOnTheFly([null,{"name":"clickTo","qid":"1","text":"Request for Leave","type":"control_head"},{"name":"submit","qid":"2","text":"Request Leave","type":"control_button"},{"name":"name","qid":"3","text":"Name","type":"control_fullname"},{"name":"position","qid":"4","text":"Position","type":"control_textbox"},{"name":"manager","qid":"5","text":"Manager","type":"control_textbox"},{"name":"phoneNumber6","qid":"6","text":"Phone Number","type":"control_phone"},{"name":"employeeId","qid":"7","subLabel":"8 digit employee ID","text":"Employee ID","type":"control_number"},{"name":"clickTo8","qid":"8","text":"Details of Leave","type":"control_head"},{"name":"leaveType","qid":"9","text":"Leave Type","type":"control_radio"},{"name":"leaveStart","qid":"10","text":"Leave Start","type":"control_datetime"},{"name":"leaveEnd","qid":"11","text":"Leave End","type":"control_datetime"},{"name":"comments","qid":"12","text":"Comments","type":"control_textarea"}]);}, 20);
</script>
</head>
<body>
<form class="jotform-form" action="C:\Users\HP\Desktop\Employee Menu/EmpMenu.html" method="post" name="form_201034088418450" id="201034088418450" accept-charset="utf-8" autocomplete="on">
<input type="hidden" name="formID" value="201034088418450" />
<input type="hidden" id="JWTContainer" value="" />
<input type="hidden" id="cardinalOrderNumber" value="" />
<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-large">
<div class="header-text httal htvam">
<h1 id="header_1" class="form-header" data-component="header">
Request for Leave
</h1>
<div id="subHeader_1" class="form-subHeader">
Request your leave details down below.
</div>
</div>
</div>
</li>
</li>
<li class="form-line" data-type="control_fullname" id="id_3">
<label class="form-label form-label-left form-label-auto" id="label_3" for="first_3"> Name </label>
<div id="cid_3" class="form-input">
<div data-wrapper-react="true">
<span class="form-sub-label-container " style="vertical-align:top" data-input-type="first">
<input type="text" id="first_3" name="q3_name[first]" class="form-textbox" size="10" value="" data-component="first" aria-labelledby="label_3 sublabel_3_first" />
<label class="form-sub-label" for="first_3" id="sublabel_3_first" style="min-height:13px" aria-hidden="false"> First Name </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top" data-input-type="last">
<input type="text" id="last_3" name="q3_name[last]" class="form-textbox" size="15" value="" data-component="last" aria-labelledby="label_3 sublabel_3_last" />
<label class="form-sub-label" for="last_3" id="sublabel_3_last" style="min-height:13px" aria-hidden="false"> Last Name </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_number" id="id_7">
<label class="form-label form-label-left form-label-auto" id="label_7" for="input_7"> Employee ID </label>
<div id="cid_7" class="form-input">
<span class="form-sub-label-container " style="vertical-align:top">
<input type="number" id="input_7" name="q7_employeeId" data-type="input-number" class=" form-number-input form-textbox validate[Numeric]" style="width:60px" size="5" value="" placeholder="ex: 12345678" data-component="number" aria-labelledby="label_7 sublabel_input_7" step="any" />
<label class="form-sub-label" for="input_7" id="sublabel_input_7" style="min-height:13px" aria-hidden="false"> 8 digit employee ID </label>
</span>
</div>
</li>
<li class="form-line" data-type="control_phone" id="id_6">
<label class="form-label form-label-left form-label-auto" id="label_6" for="input_6_area"> Phone Number </label>
<div id="cid_6" class="form-input">
<div data-wrapper-react="true">
<span class="form-sub-label-container " style="vertical-align:top" data-input-type="areaCode">
<input type="tel" id="input_6_area" name="q6_phoneNumber6[area]" class="form-textbox" size="6" value="" data-component="areaCode" aria-labelledby="label_6 sublabel_6_area" />
<span class="phone-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="input_6_area" id="sublabel_6_area" style="min-height:13px" aria-hidden="false"> Area Code </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top" data-input-type="phone">
<input type="tel" id="input_6_phone" name="q6_phoneNumber6[phone]" class="form-textbox" size="12" value="" data-component="phone" aria-labelledby="label_6 sublabel_6_phone" />
<label class="form-sub-label" for="input_6_phone" id="sublabel_6_phone" style="min-height:13px" aria-hidden="false"> Phone Number </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_4">
<label class="form-label form-label-left form-label-auto" id="label_4" for="input_4"> Position </label>
<div id="cid_4" class="form-input">
<input type="text" id="input_4" name="q4_position" data-type="input-textbox" class="form-textbox" size="20" value="" placeholder=" " data-component="textbox" aria-labelledby="label_4" />
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_5">
<label class="form-label form-label-left form-label-auto" id="label_5" for="input_5"> Manager </label>
<div id="cid_5" class="form-input">
<input type="text" id="input_5" name="q5_manager" data-type="input-textbox" class="form-textbox" size="20" value="" placeholder=" " data-component="textbox" aria-labelledby="label_5" />
</div>
</li>
<li id="cid_8" class="form-input-wide" data-type="control_head">
<div class="form-header-group header-small">
<div class="header-text httal htvam">
<h3 id="header_8" class="form-header" data-component="header">
Details of Leave
</h3>
</div>
</div>
</li>
</li>
<li class="form-line" data-type="control_datetime" id="id_10">
<label class="form-label form-label-left form-label-auto" id="label_10" for="month_10"> Leave Start </label>
<div id="cid_10" class="form-input">
<div data-wrapper-react="true" class="extended">
<span class="form-sub-label-container " style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="month_10" name="q10_leaveStart[month]" size="2" data-maxlength="2" maxLength="2" value="04" autoComplete="off" aria-labelledby="label_10 sublabel_10_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_10" id="sublabel_10_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top">
<input type="tel" class="currentDate form-textbox validate[limitDate]" id="day_10" name="q10_leaveStart[day]" size="2" data-maxlength="2" maxLength="2" value="13" autoComplete="off" aria-labelledby="label_10 sublabel_10_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_10" id="sublabel_10_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="year_10" name="q10_leaveStart[year]" size="4" data-maxlength="4" maxLength="4" value="2020" autoComplete="off" aria-labelledby="label_10 sublabel_10_year" />
<label class="form-sub-label" for="year_10" id="sublabel_10_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top">
<img class="showAutoCalendar newDefaultTheme-dateIcon icon-seperatedMode" alt="Pick a Date" id="input_10_pick" src="https://cdn.jotfor.ms/images/calendar.png" style="vertical-align:middle;margin-left:5px" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v1" />
<label class="form-sub-label" for="input_10_pick" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap" aria-hidden="true"> Date Picker Icon </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_datetime" id="id_11">
<label class="form-label form-label-left form-label-auto" id="label_11" for="month_11"> Leave End </label>
<div id="cid_11" class="form-input">
<div data-wrapper-react="true" class="extended">
<span class="form-sub-label-container " style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="month_11" name="q11_leaveEnd[month]" size="2" data-maxlength="2" maxLength="2" value="04" autoComplete="off" aria-labelledby="label_11 sublabel_11_month" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="month_11" id="sublabel_11_month" style="min-height:13px" aria-hidden="false"> Month </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top">
<input type="tel" class="currentDate form-textbox validate[limitDate]" id="day_11" name="q11_leaveEnd[day]" size="2" data-maxlength="2" maxLength="2" value="13" autoComplete="off" aria-labelledby="label_11 sublabel_11_day" />
<span class="date-separate" aria-hidden="true">
-
</span>
<label class="form-sub-label" for="day_11" id="sublabel_11_day" style="min-height:13px" aria-hidden="false"> Day </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top">
<input type="tel" class="form-textbox validate[limitDate]" id="year_11" name="q11_leaveEnd[year]" size="4" data-maxlength="4" maxLength="4" value="2020" autoComplete="off" aria-labelledby="label_11 sublabel_11_year" />
<label class="form-sub-label" for="year_11" id="sublabel_11_year" style="min-height:13px" aria-hidden="false"> Year </label>
</span>
<span class="form-sub-label-container " style="vertical-align:top">
<img class="showAutoCalendar newDefaultTheme-dateIcon icon-seperatedMode" alt="Pick a Date" id="input_11_pick" src="https://cdn.jotfor.ms/images/calendar.png" style="vertical-align:middle;margin-left:5px" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v1" />
<label class="form-sub-label" for="input_11_pick" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap" aria-hidden="true"> Date Picker Icon </label>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_radio" id="id_9">
<label class="form-label form-label-left form-label-auto" id="label_9" for="input_9"> Leave Type </label>
<div id="cid_9" class="form-input">
<div class="form-single-column" role="group" aria-labelledby="label_9" data-component="radio">
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_9_0" name="q9_leaveType" value="Vacation" />
<label id="label_input_9_0" for="input_9_0"> Vacation </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_9_1" name="q9_leaveType" value="Sick" />
<label id="label_input_9_1" for="input_9_1"> Sick </label>
</span>
<span class="form-radio-item" style="clear:left">
<span class="dragger-item">
</span>
<input type="radio" class="form-radio" id="input_9_2" name="q9_leaveType" value="Quitting" />
<label id="label_input_9_2" for="input_9_2"> Quitting </label>
</span>
<span class="form-radio-item" style="clear:left">
<input type="radio" class="form-radio-other form-radio" name="q9_leaveType" id="other_9" value="other" aria-label="Other" />
<label id="label_other_9" style="text-indent:0" for="other_9"> </label>
<input type="text" class="form-radio-other-input form-textbox" name="q9_leaveType[other]" data-otherhint="Other" size="15" id="input_9" tabindex="-1" placeholder="Other" />
<br/>
</span>
</div>
</div>
</li>
<li class="form-line" data-type="control_textarea" id="id_12">
<label class="form-label form-label-left form-label-auto" id="label_12" for="input_12"> Comments </label>
<div id="cid_12" class="form-input">
<textarea id="input_12" class="form-textarea" name="q12_comments" cols="40" rows="6" data-component="textarea" aria-labelledby="label_12"></textarea>
</div>
</li>
<li class="form-line" data-type="control_button" id="id_2">
<div id="cid_2" class="form-input-wide">
<div style="margin-left:156px" data-align="auto" class="form-buttons-wrapper ">
<button id="input_2" type="submit" class="form-submit-button" data-component="button" data-content="">
Request Leave
</button>
</div>
</div>
</li>
</ul>
</div>
<input type="hidden" id="simple_spc" name="simple_spc" value="201034088418450" />
<script type="text/javascript">
document.getElementById("si" + "mple" + "_spc").value = "201034088418450-201034088418450";
</script>
<div class="formFooter-heightMask">
</div>
</form></body>
</html>