TIME-OFF REQUEST Name * First Name Last Name Time Off Request * Days Hours How Many Days or Hours * Depending on hours or days checked above 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Beginning On * MM DD YYYY Reason for Request * Vacation Personal Leave Funeral Family Reasons Medical Jury Duty Other I understand that this request is subject to approval by my employer. * Please type name to confirm. Thank you! Your time off request has been submitted and will be reviewed. You will receive an answer shortly.
