Employee Time Off Request Form

Employee Time Off Request Form
Name*

First NameLast Name
Email*
example@example.com
From Date*

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
To Date*

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Number of Day Requested*
Type of Request*

VacationSick TimeMaternity LeaveFamily & Medical LeaveBereavement LeaveJury Duty
Employee Certification:*

I understand that time away from work is subject to management approval and firm policies.
Comment:
Today's Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty: