Time Off Request
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Use this form to manage and document employee's requests for time off work. The template
includes space for the employee to indicate the time requested, reason for the request plus
any comments they want to add. The supervisor review the request is provided space to approve, disapprove or modify the
requested time off along with a section for comments to provide an explanation.
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EMPLOYEE
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REVIEWED BY
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NAME
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NAME
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POSITION
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POSITION
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DATE SUBMITTED
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DATE REVIEWED
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TYPE OF REQUEST
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Vacation
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Appointment (doctor, dentist, etc)
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Personal holiday
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Bereavement/Funeral leave
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Sick time
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Leave of absence
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FMLA time
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Compensated days
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Jury duty
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Leave without pay
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Military leave
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Other - Explain:
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EMPLOYEE COMMENTS
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STATUS OF TIME OFF REQUEST
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SUPERVISOR COMMENTS
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