TIME OFF REQUEST FORM

TIME OFF REQUEST FORM
Your request for time off must be submitted and approved by management in advance. Submitting this form doesn’t grant the day off. Please consult with the management before you buy tickets/ plan your travel etc.
EMPLOYEE INFORMATION
Name

First NameMiddle NameLast Name
Email
example@example.com
TODAY’S DATE:

MonthDayYear
Date
STORE:
VACATION DAYS AVAILABLE:
AS OF (DATE):

MonthDayYear
Date
NUMBER OF DAYS REQUESTED:
STARTING ON:

MonthDayYear
Date
ENDING ON:

MonthDayYear
Date
I WILL RETURN TO WORK ON:
TYPE OF REQUEST
Type a question

VACATIONMILITARY LEAVEPERSONAL LEAVEFAMILY AND MEDICAL LEAVEBEREAVEMENT LEAVESICK TIMEJURY DUTYTIME OFF TO VOTE
COMMENTS
Please write your comments here
EMPLOYEE CERTIFICATION
I understand that time away from work is subject to management approval and company policies.
Signature Date:

MonthDayYear
Date
APPROVAL
Approved

YesNo
Supervisor/Manager Approval:
Signature Date:

MonthDayYear
Date
Printed Name:

TitleFirst NameLast Name
Payroll Input:
Signature Date:

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

EMPLOYEE INFORMATION