Employee Time-Off Request Form

Employee Time-Off Request Form
Employee Name:*
Time-Off Request Date:

MonthDayYear
Date
Last Day of Dispatch:

MonthDayYear
Date
End Time:

:HourMinutes
Available for Dispatch:

MonthDayYear
Date
Start Time:

:HourMinutes
Reason for Request:

VacationPersonal LeaveFuneral/BereavementJury DutyFamily ReasonsMedical LeaveTo VoteOther
How I would like paid:

VacationSickNo Pay
I understand that this request is subject to approval by my employer.
Employee's Signature*

Clear
Signature Date:

MonthDayYear
Date
Should be Empty: