Time Off Request
Employees must submit time off requests to the Right at Home administrative office as far in advance as possible (a minimum of two weeks prior to start date is required for vacation time.) Requests will be evaluated based on a number of factors, including business needs and staffing requirements. Employees will be notified within 3 business days after receipt of this form whether the time off requested has been approved or denied.
Employee Name:
*
Date Submitted:
*
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Date Picker Icon
Employee Email:
*
Please Select One:
*
Please Select
Vacation
Personal Day(s)
FMLA Leave
Other
Explanation of request:
*
Date(s) Requested off:
*
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2025
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Return to Work On:
*
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January
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2025
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Employee signature:
*
Time:
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AM/PM Option
Submit
Office use only
Date request received:
Approved / Denied by:
Date:
Office Notes:
Should be Empty: