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Time Off Request Form

The document is an Employee Time-Off Request Form that allows employees to request time off by providing their name, dates, and total hours or days requested. Employees can indicate if they wish to use vacation, sick, or other leave types for payment. The request requires a signature from both the employee and employer, and should be submitted at least two weeks in advance, except in emergencies.

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littlebookwerm
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6 views

Time Off Request Form

The document is an Employee Time-Off Request Form that allows employees to request time off by providing their name, dates, and total hours or days requested. Employees can indicate if they wish to use vacation, sick, or other leave types for payment. The request requires a signature from both the employee and employer, and should be submitted at least two weeks in advance, except in emergencies.

Uploaded by

littlebookwerm
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Employee Time-Off Request Form

Employee’s Name: __________________


Date___________

Start Date: ____________________


End Date: ____________________
Return to work Date: __________________

Total Hours Requested: ______________


Total Days Requested: ______________

If available/applicable, do you want to use your Vacation/Sick Hours


to get paid?
☐ - YES ☐ - NO
☐ - Vacation Hours(PTO) ☐ - Sick Hours ☐ - Bereavement Hours (3 days)

☐ - Medical Leave of Absence ☐ - Personal Leave of Absence (no pay)

☐ - Other: _____________________________________

Other than Emergency situations, please put in a request at least two weeks in advance.

I understand that this request is subject to approval by my employer.

Employee’s Signature: ________________________ Date: ___________

-------------------------------------------------------
Employer Only
☐ - Approved ☐ - Rejected

Name: ________________________ Date: ____________

Signature: _____________________

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