Please Complete Time Off Request Form "*" indicates required fields Employee Name* Please Select One:* Vacation Personal Holiday Sick leave Bereavement Leave Other (Explain Below) Reason for Time Off:Date Submitted* MM slash DD slash YYYY Total Number of Days Off* *Not including Weekend DaysBeginning Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Return to Work Date* MM slash DD slash YYYY 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:*NameThis field is for validation purposes and should be left unchanged.
