TIME OFF REQUEST FORM
DATE REQUEST ENTERED
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Month
-
Day
Year
Date Picker Icon
Name
First Name
Last Name
REASON FOR REQUESTING
VACATION
ABSENT
MILITARY
MEDICAL
NO POINTS, NO PAY
BEREAVEMENT
FMLA
JURY DUTY
EMERGENCY WEATHER
PERSONAL
DISCIPLINE
COURT
Full Day or Half Day
Full Day
Half Day
SINGLE, RANGE OR MULTIPLE
1 DAY OFF
RANGE OF DATES OFF
MULTIPE DATES OFF (NOT CONSECUTIVE)
SINGLE DAY OFF
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Month
-
Day
Year
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START DATE (FIRST DAY OF TIME OFF)
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Month
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Day
Year
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END DATE (LAST DAY OF TIME OFF)
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Month
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Day
Year
Date Picker Icon
DAY 1
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Month
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Day
Year
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DAY 2
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Month
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Day
Year
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DAY 3
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Month
-
Day
Year
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DAY 4
-
Month
-
Day
Year
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DAY 5
-
Month
-
Day
Year
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DAY 6
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Month
-
Day
Year
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DAY 7
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Month
-
Day
Year
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DAY 8
-
Month
-
Day
Year
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DAY 9
-
Month
-
Day
Year
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DAY 10
-
Month
-
Day
Year
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DAY 11
-
Month
-
Day
Year
Date Picker Icon
USE VACATION HOURS?
YES
NO
ALL NOTES FOR ABSENTEEISM, FOR MEDICAL LEAVE, JURY DUTY, MILITARY, FMLA, PERSONAL, AND COURT SHOULD BE TURNED IN WITH THIS FORM.
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TIME OFF REQUEST STATUS
APPROVED
NOT APPROVED
REQUESTED
FLORIDA TOOL EMPLOYEE TIME OFF APPROVED BY
HETZA
LESLIE
RYAN
COMMENTS
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