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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.

Time Off Request Form

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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________________________________< _______________________ Date_____