Time Off Request
This form is to be used for all Time Off requests
Associate Name:
*
First Name
Last Name
Email
*
example@example.com
Employee # (your timeclock #):
*
Type of Request
*
Please Select
Day(s) Off
Leave Early
Late Start
Cancel Previous Request
What previously requested Time Off Date(s) to Cancel?
*
Request Start Date
*
-
Month
-
Day
Year
Date Picker Icon
Return To Work Date
*
-
Month
-
Day
Year
Date Picker Icon
Number of Days
*
Number of Hours
*
Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Reason for request?
*
ex: Appointment, Vacation, School, etc.
PLEASE NOTE DOCUMENTATION MAY BE REQUESTED AS PART OF THE APPROVAL PROCESS
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.
*
Submit
Should be Empty: