HPU FORM | Absense Request Form – HPU | Hibbing Public Utilities

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WHO WE ARE
my HPU
Outages
- Report A Problem
- FAQ
COMMUNITY
Employee Portal

Submit A Service Request

Employee Dashboard

Hibbing Public Utilities

Absense Request Form

Download the PDF or Fill out online.

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Absence Request Form

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Full Name *

Current Date *

Date

Time

Department *

Full Days Unavailable (Date Range) *

Half Days Unavailable (Date Range)

Checkboxes *

Vacation
Comp time
Personal (full day only)
Furlough (full day only)
Jury Duty
Military
Funeral, for death of

Sick Leave

Self - personal injury
Self - work related injury
Spouse Mother/Father-in-law
Parent/Stepparent
Child
Grandparent
Sibling
Grandchild

for death of

Doctor Excuse Attached

Yes
No

*Sick leave of one hour or less, with a doctor note will not be deducted from your sick leave balance for appointments you are unable to schedule outside of work hours.

Employee Sick and Safe Time

Yes
No

Returned to work Date *

Employee Signature *

Clear Signature

Half Date Date

Foreman Signature

Clear Signature

Manager Signature

Clear Signature

Date / Time

Approval

Approved
Denied, explain

Paragraph Text

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any questions or issues with the form.

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