Time Off Request Form printable pdf download

Time Off Request Form

*Vacation requests must be submitted 2 weeks prior to date requesting off.

__________________________

Date:

___________________________________________

Name:

______________________________________________________________________________________

Reason:

_____________________________________________________________________________________________

Please indicate which day(s) you would to request off:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Date:

Hours:

*You may only fill out one time off request per pay period

Returning to Work: ____/____ /______

Total Number of Hours Requested: ____________ Hours

Number of Hours Requested to be Paid: ______________ Hours (upon HR approval)

Please indicate:

Vacation Pay

Sick Pay

_______________________________________________________________________

Employee Signature:

_______________________________________________________

Approved

Denied

By:

________________________________________________

Print Name:

_____________________________________________

Date Approved:

*********************************************************************************************

For HR Use Only

Number of Available Hours: _________ Vacation _________ Sick

Number of Hours Approved: _________ Vacation

_________ Sick

Revised by: United Water Restoration Human Resources Department 5/13/15

Time Off Request Form