Time Off Request
This form is to be used for all Unpaid Time Off (UTO)
Associate Name:
*
First Name
Last Name
Employee #:
*
Department | Position
*
Please Select
Picking
Picking Singles
QC Ship
QC Ship Singles
Dock
Boxbuild
Putaway
Receiving
Trainer
Shift Schedule
*
Please Select
DI
DD
DF
DB
DW
NF
ND
NB
NW
Type of Request
*
Please Select
Day(s) Off
Leave Early
Late Start
Cancel Previous UTO Request
What previously requested UTO Date(s) to Cancel?
*
Request Start Date
*
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Month
-
Day
Year
Date Picker Icon
Return To Work Date
*
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Month
-
Day
Year
Date Picker Icon
Number of Days
*
Number of Hours
*
Time
*
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:
Hour
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Minutes
AM
PM
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.
*
Date
*
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Month
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Day
Year
Date
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Hour
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Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: