Employee Time-Off Request Form
Employee Name:
*
Time-Off Request Date:
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Date
Last Day of Dispatch:
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End Time:
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:
Hour
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Minutes
Available for Dispatch:
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Date
Start Time:
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Hour
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50
Minutes
Reason for Request:
Vacation
Personal Leave
Funeral/Bereavement
Jury Duty
Family Reasons
Medical Leave
To Vote
Other
How I would like paid:
Vacation
Sick
No Pay
I understand that this request is subject to approval by my employer.
Employee's Signature
*
Signature Date:
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Month
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Day
Year
Date
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Submit
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