Time Off Request Form

Request for Time Off
Employee's Name*

First NameLast Name
Please note that half-day requests can only be made at least seven days in advance.
Full DayHalf Day (morning off)Half Day (afternoon off)
Please note that the drop-off or pick-up time for a half day is 11:30 a.m. ONLY. Employees taking a half-day should plan to arrive or leave promptly at 11:30.
Full-Day Date Requested Off*

MonthDayYear
Half-Day Date Requested Off*

MonthDayYear
Paid Time Off (PTO)Unpaid Absence
Reason for PTO
Date of Employee's Return to Work*

MonthDayYear
Total Number of Days Requested*
Your Name*

First NameLast Name
Your E-mail
Note
Type any extra information you'd like to include here.
Should be Empty:

Request for Time Off