Time Off Request Form

TIME OFF REQUEST

Date:

From:

Time off Request

Subject:

I would like to request the following time off:

Please check the appropriate box:

Sick

Vacation/Personal Day

Unpaid

Jury Duty

Bereavement Leave

Other, ______________________________

List Date(s) Requested:

The total number of Hours/Days I am requesting is: ___

Employee Signature:

_______________________ Date: _____________

Supervisor Signature: _______________________ Date: _____________

Human Resource Signature: __________________ Date: _____________

Time Off Approved:

Time Off Denied:

H:\Human Resource Forms\HR Forms\Time Off Request.doc

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Parent category: Business