Vacation Request Form

Vacation Request Form
Paid vacation time is a benefit that the Company grants to full time employees. Vacation time is accrued based on hours worked such that employees will start to accrue a maximum of:
- 40 hours per year at their hire date,
- 80 hours after the fourth anniversary of their hire date,
- 120 hours after the ninth anniversary of their hire date, and
- 160 hours after the fourteenth anniversary of their hire date.
The maximum amount of accrued vacation allowed is 160 hours. Once an employee reaches the maximum amount allowed, vacation hours will no longer accrue. You need to manage your vacation usage to avoid losing vacation time.

All employees are required to give at least two weeks’ notice to their supervisor of their vacation plans. Any conflict in vacation requests will be decided based on employee seniority and Company needs. Employees that accrue 120 or more hours per year must take one full week (Monday – Friday) one time per year. Please see the Employee Handbook for the complete policy.
Today's Date*

MonthDayYear
Date
Name*

First NameLast Name
Supervisor*
What are you requesting?*

1/2 Day OffOne Day OffMultiple Days Off
Date Requesting*

MonthDayYear
Date
Start Date:*

MonthDayYear
This is the first date you are requesting off.
End Date:*

MonthDayYear
This is your last day of vacation.
If you would like a copy of your request, please enter your email address here.
example@example.com
Comments
Vacation Hours Accrued:
Sick Hours Accrued:
Number of Days Approved
Approved By:
Comments:
Please note that submission of this form does not mean your vacation has been approved. Your request will be forwarded to your supervisor for approval. If you haven't received a response from your supervisor in one week, please follow up with them to confirm approval.
Should be Empty: