TIME OFF REQUEST FORM

TIME OFF REQUEST FORM
Requests for time off must be submitted to management via this form two business weeks prior to the date(s) of the time off.
Name

First NameLast Name
Today's Date

MonthDayYear
Date
Employee's Email
example@example.com
Start Leave Date

MonthDayYear
Date
Time
Reason

Doctor/Dental AppointmentFuneral/BereavementPersonalVacationLeaving EarlyIn LateOther
If "Other" is selected, detail below*
Return To Work Date

MonthDayYear
Date
Time
I understand time off request both (Paid or Unpaid) will be honored provided my shift is adequately covered and staffed during the time I have requested time off and that management reserves the rights to change this request within a reasonable time due to an emergency. I also, understand that submitting this request does not guarantee approval
SIGNATURE

Clear
OFFICIAL USE ONLY SECTION FOR MANAGEMENT
Time Request Off is

APPROVEDDENIED
REASON
REVIEWED BY
Should be Empty: