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2023 Time Off Request Form

The document is a 2023 Vacation/Time Off Request Form for employees to request vacation, sick leave, or unpaid time off. It includes sections for employee details, hours requested, specific dates, and a calendar for marking days off. Supervisors are required to approve or deny the requests and provide documentation for unpaid absences to be excused.

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jp5249934
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Download as XLSX, PDF, TXT or read online on Scribd
7 views

2023 Time Off Request Form

The document is a 2023 Vacation/Time Off Request Form for employees to request vacation, sick leave, or unpaid time off. It includes sections for employee details, hours requested, specific dates, and a calendar for marking days off. Supervisors are required to approve or deny the requests and provide documentation for unpaid absences to be excused.

Uploaded by

jp5249934
Copyright
© © All Rights Reserved
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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2023 Vacation/Time Off Request Form

Employee Name: Date of Request: / /

# Unscheduled/Unused Hours Available to Employee: Vacation: Paid Sick: Unpaid Sick:

# of Hours Requested: Vacation Unpaid Time: FMLA ____ Yes ____ No

First Day Off: / / Return to Work Date: / /

If partial day, list the times you will work: Start: am/pm Stop: am/pm

If requesting unpaid days, please list the reason for the absence:

Please mark the days you will be off on the calendar below.
Company Holidays are highlighted in yellow.
Use "V" for vacation, "S" for Sick Time, "A" for unpaid absences, "F" for FMLA time.

2023
JANUARY FEBRUARY MARCH APRIL
S M T W T F S S M T W T F S S M T W T F S S M T W T F S

1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 1

8 9 10 11 12 13 14 5 6 7 8 9 10 11 5 6 7 8 9 10 11 2 3 4 5 6 7 8

15 16 17 18 19 20 21 12 13 14 15 16 17 18 12 13 14 15 16 17 18 9 10 11 12 13 14 15

22 23 24 25 26 27 28 19 20 21 22 23 24 25 19 20 21 22 23 24 25 16 17 18 19 20 21 22

29 30 31 26 27 28 26 27 28 29 30 31 23 24 25 26 27 28 29

30

MAY JUNE JULY AUGUST


S M T W T F S S M T W T F S S M T W T F S S M T W T F S
1 2 3 4 5 6 1 2 3 1 1 2 3 4 5

7 8 9 10 11 12 13 4 5 6 7 8 9 10 2 3 4 5 6 7 8 6 7 8 9 10 11 12

14 15 16 17 18 19 20 11 12 13 14 15 16 17 9 10 11 12 13 14 15 13 14 15 16 17 18 19

21 22 23 24 25 26 27 18 19 20 21 22 23 24 16 17 18 19 20 21 22 20 21 22 23 24 25 26

28 29 30 31 25 26 27 28 29 30 23 24 25 26 27 28 29 27 28 29 30 31

30 31

SEPTEMBER OCTOBER NOVEMBER DECEMBER


S M T W T F S S M T W T F S S M T W T F S S M T W T F S
1 2 1 2 3 4 5 6 7 1 2 3 4 1 2

3 4 5 6 7 8 9 8 9 10 11 12 13 14 5 6 7 8 9 10 11 3 4 5 6 7 8 9

10 11 12 13 14 15 16 15 16 17 18 19 20 21 12 13 14 15 16 17 18 10 11 12 13 14 15 16

17 18 19 20 21 22 23 22 23 24 25 26 27 28 19 20 21 22 23 24 25 17 18 19 20 21 22 23

24 25 26 27 28 29 30 29 30 31 26 27 28 29 30 24 25 26 27 28 29 30

31

Employee Signature:

* Employee must present documentation for unpaid absence to be excused (not count negatively toward attendance.)

For supervisor to complete: Time off request is: Approved Pending - not yet approved

Denied - Reason:

Supervisor's Signature: Date: / /

Excused: Yes No (Will count against employee for attendance and annual review.)

Original to HR Copy to Supervisor Copy to Employee Copy to Payroll

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