Time-Off Request Form

Time Off Request

Use a separate form for each time off request.

Today's Date: ______/______/_______

Name:

Title/Position:

Supervisor:

Date(s) requested off: ______/______/_______ through ______/______/_______

Type of Absence:

Paid Vacation: _________hrs.

Paid Float: ____________hrs.

Unpaid Time Off

Is this a Leave of Absence? If so, please see the Administrator.

Reason for Request:

Administrator Approval:

Approved

Not Approved

Reason/Comments:

Administrator Signature

Office Manager Signature (when entered into schedule)

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Parent category: Business