Employee Time-Off Request Form
Full Name
*
First Name
Last Name
Reason for Time Off
*
Sick
Vacation
Personal
Bereavement
Jury Duty
Other
Date of Time Off Needed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Time Off Needed Until
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: