Time-Off Request Form

Time-Off Request Form
Name

First NameLast Name
Today's Date:

MonthDayYear
Date
Email
Email you would like to be notified for approval status.
Choose your department
Lead Name:
FROM

MonthDayYear
Dates Requested Off:
TO

MonthDayYear
Dates Requested Off:
Returning Back to Work On:

MonthDayYear
Choose the date you will return.
Choose your Nuetral Absence Option:
UTO Balance
Unpaid Time Off Balance
PTO Balance
Paid Time Off Balance
Rough & Trim Crews

REQUIRED: If you are a rough & trim crew members please fill the contents below. If you are not please skip this section.
Are you a crew lead?
If YES select who will drive the company truck.
Employee Agreeing to Commit to Lead Duties when the Lead is absent
Crew Leads Signature
Technicians & Coordinators

REQUIRED: If you are a Technician or a Coordinator please fill the contents below. If you are not please skip this section.
Are you on call during the requested dates?
If YES select who will cover your on call responsibilities.
Employee Agreeing to Cover On Call
Effected Employee Signature
Effected Employee Signatures

Below are for any additional signatures needed for employee's affected by your absence in your department or other departments.
Effected Employee Signature
Effected Employee Signature
Final Signature Before Submission

Employee submitting request
Employee Signature
Should be Empty:

Rough & Trim Crews