TIME OFF REQUEST FORM
Vacation/PTO time may only be used for week days (Monday-Friday)
Which division?
*
37 Trucking
37 Building Products
37 Mining
Fleet Maintenance
Employee Name
*
Last 4 of SSN
Date
-
Month
-
Day
Year
TYPE OF REQUEST
Type a question
Vacation
Jury Duty - Must provide documentation
PTO
Time off without pay
Other
Number of Days/Hours Requested
Beginning On
*
-
Month
-
Day
Year
Ending On
*
-
Month
-
Day
Year
I will return to work on
*
-
Month
-
Day
Year
Comments
EMPLOYEE CERTIFICATION
I understand that time away from work is subject to management approval and company policies.
Signature
Clear
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: