Time Off Request
Please submit time off requests at least 2 weeks in advance (3 weeks for holidays and vacations).
Employee Name
First Name
Last Name
Request Type
Time Off
Vacation (Consecutive days)
Date 1
-
Month
-
Day
Year
Date
Date 2
-
Month
-
Day
Year
Date
Date 3
-
Month
-
Day
Year
Date
Date 4
-
Month
-
Day
Year
Date
Date 5
-
Month
-
Day
Year
Date
If you need to request additional dates, please fill out another form
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
RETURN TO WORK DAY
-
Month
-
Day
Year
Date
Comments
Enter your E-mail to be notified when your request has been reviewed
example@example.com
Save
Submit
click here to enter supervisor's comments
Supervisor's Approval
Yes
No
Supervisor's Note
Reviewed By By
First Name
Last Name
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Submit and Notify Employee
Should be Empty: