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Time Off Requst Form

Have your employees fill out this time off request form for them to receive approval to take time off from work.

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Time Off Request Form

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Time Off Request

Please Check One:

[__] Vacation

[__] Personal Holiday

[__] Sick Leave

[__] FMLA

[__] Leave w/o Pay

[__] Summer Leave

[__] Other

Other: _____________________________



Name: ______________________________

Date Submitted: ____/____/_____

Total Number of Days Requested: _____

Starting Date: ___/___/_____

Return to Work: ___/___/_____

Approved By: _______________________Date: ___/___/_____

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Time Off Request
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