Time Off Request NV1

Time Off Request

This form is to be used for all Unpaid Time Off (UTO)
Associate Name: *

First Name Last Name
Employee #: *
Department | Position *
Shift Schedule *
Type of Request *
What previously requested UTO Date(s) to Cancel? *
Request Start Date *

Month Day Year
Return To Work Date *

Month Day Year
Number of Days *
Number of Hours *
Time *

: Hour Minutes AM/PM Option
Reason for request? *
ex: Appointment, Vacation, School, etc.
Employee Please Print Name: *
Employee Signature: By signing below, I acknowledge I understand that time away from work is subject to: IntelliSource management approval, company policies, and business needs. *
Should be Empty: