Employee Time Off Request Form

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SHEAKLEY HR, LLC
Employee Time Off Request Form
Time Off Information
Employee Name:
Employee SSN:
Department:
Client Company
Type of Absence Requested:
Sick
Vacation
Bereavement
Time Off Without Pay
Family Medical
Military
Jury Duty
Leave (FMLA)
Other
Dates of Leave
From:
To:
Reason for Leave:
Your request for time off, other than sick leave, must be submitted, scheduled and approved by your manager,
two weeks prior to the first day you will be on leave.
Employee Signature
Date
Manager Approval
Approved
Rejected
Comments:
Manager Signature
Date

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