United Employment Solutions: Sick Leave Form

Please only fill out this form if you are an active and working employee with United Employment Solutions.  This is not valid for applicants. You must be working at a site and under United Employment Solutions’ payroll. By filling out this form, this does not guarantee you your sick hours, this is a request, additional questions and proof may be requested. Thank you.

Name
Please provide the last 4 SSN that is associated with your account.
Date / Time
Please choose one. Please not that this is a request and is not guaranteed to be paid or excused. We will review each request and determine by each case.
Please describe your situation and why you need time off.