Time Off Request Form
Name
*
First Name
Last Name
Todays Date
*
/
Month
/
Day
Year
Email
*
Confirmation Email
Confirm Email
Start Leave Date
*
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Last Day Of Leave
*
/
Month
/
Day
Year
Date of last day off/ Return to work next day
AM
PM
AM/PM Option
Reason For Time Off Requests
*
If sick leave is available for this leave would you like to use it?
Please Select
Not Available
Yes
No
Vacation time is subject to management Approval
Time off Request is:
PENDING
APPROVED
DENIED
Reason Request Was Denied
Approved By
Submit Request
Should be Empty: