LCTY Staff Time Off Form

LCTY Staff Time Off Form
Please submit this form to notify the office at least 60 days in advance of your preferred vacation dates. This form will be required to be submitted if requesting time exceeds 3 consecutive hours.
Employee Name

First NameLast Name
Vacation From Date:

MonthDayYear
Vacation To Date:

MonthDayYear
Returning to Work Date:

MonthDayYear
Total Number of Days/Hours Requested:
Employee Signature

Clear
Date

MonthDayYear
Date
Should be Empty: