Time Off Request KS1

Time Off Request

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

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

MonthDayYear
Return To Work Date*

MonthDayYear
Number of Days*
Number of Hours*
Time*

:HourMinutesAM/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: