Please Complete Time Off Request Form "*" indicates required fields NameThis field is for validation purposes and should be left unchanged.Employee Name*Please Select One:* Vacation Personal Holiday Sick leave Bereavement Leave Other (Explain Below) Reason for Time Off:Date Submitted* Total Number of Days Off**Not including Weekend DaysBeginning Date* End Date* Return to Work Date* I understand that time away from work is subject to approval. I further understand that if I do not have leave accrued, I will not be paid for the absence.USE AVAILABLE LEAVE* Yes No N/A LEAVE WITHOUT PAY* Yes No N/A Employee Signature:*Completed
