Employee Time Off Request
Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Configurable list
*
What shift do you work?
*
7:30am or 7:45am (we request end of day appt scheduling)
8:00am (we request beginning of day appt scheduling)
Type or request
*
Full Day
Half Day
Time period requesting for half day (i.e., 9:30-11 am)
Reason for request
Please Select
Child appointment
Appointment for self
Personal matter
Must provide excuse note.
Reason for request comments (optional)
Is this request 2 weeks in advance?
*
Yes
No
Are you in the 180-day probationary period?
Yes
No
Have you requested time off or have been absent in the last 30 days?
Yes
No
Employee Signature
*
Submit
Submit
For Director Use Only:
Time Off Is:
Approved
Denied
Notes
Should be Empty: