Time Off Request
Please submit multiple requests if you are planning for different obligations and/or multiple days off excluding vacations or long-term leaves. You are required to give at least 30 days' notice if you are needing a day off, to leave early, or the come later than your scheduled shift. If you are needing more than 2 days off, you are required to give at least 90 days' notice, the most notice you can give is always best. Failure to give the appropriate amount of time request may result in your request being denied. Your request will be approved or denied within 72 hours via email.
Name
First Name
Last Name
Email
example@example.com
Are you taking off a full day(s) or part of a day?
Request entire day off
Request to leave early
Request to start late
What is the start date for your requested time off?
-
Month
-
Day
Year
Date
What is the end date for your requested time off?
-
Month
-
Day
Year
Date
If you are needing to take off part of the day, include what hours you are needing off.
i.e. 8:00 AM - 12:00 PM
What is the purpose of your time off request?
Vacation
Funeral or Bereavement
Medical Appointment or Leave
Personal Day
Jury Duty
Are you using PTO?
Yes
No
Additional Comments/Concerns
Signature
Today's Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: