Scribd
Upload
14 views

Time Off Request Form

Uploaded by

harrehmatsinghjee
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
14 views

Time Off Request Form

Uploaded by

harrehmatsinghjee
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 1

Time Off / Vacation Pay Request Form Date _______________ ________

Last Name: _______________ First Name: __ _______________ Employee # _________

Site Name/Address: _______________________________________________________________________________


_
Home Address: _____________________________________________________ Postal Code: ___________

Home Phone # _____________________________ Work Phone # _________________________

Type of time off requested (please check one):


 Leave of Absence  Receiving Benefits  Vacation  Personal time  Appointment
Dates for Time Off (MM/DD/YY)
First Day Off Last Day Off First Day Returning to Work

Reason for time off (please provide details) ____ __________________


________________________________________________________________________________________

VACATION PAY REQUEST

Will you require vacation pay to be paid out during this time off?  Yes  No

If yes, will the vacation pay required be for the full amount earned or partial amount to cover the wages you would have earned during
this time off?  Full amount (indicate pay date needed by) __________________
OR  Cover normal wages during time off

Please note
 Requests for vacation time of one (1) week or more shall be made in writing at least four weeks in advance of the start of the
vacation. For requests of two (2) consecutive days but less than one (1) week, two (2) weeks’ notice must be provided. For
requests of one (1) day, one (1) week notice must be provided. Provided notice is given, vacation pay shall be paid on the day
immediately preceding the start of the employee’s vacation, if requested by the employee.
 Subject to the written request for vacation, the Employer shall grant in writing the vacation request within five (5) working days,
the vacation request will be deemed to be granted. Once approved, no vacation will be changed without mutual consent of the
Parties.

Employee Signature _______________________________

OFFICE USE Date Received: ______________________

 Request approved  Request denied Signature: ________________ Date:

Reason request denied: ____________________________________________________________________


Scheduling ______ Payroll ______ Branch Operations _____

Garda.com

When printed, document is not controlled. Master controlled by: Winnipeg Branch Revision WPG: 3.0-18
WIN 1.0
In the event of a discrepancy, the English version of this document takes precedence Page 1 of 1

You might also like