Time Off Request
EMPLOYEE INFORMATION – Please print clearly
Name (please print): Date:
Position: Department: _____ __
| REQUESTED DATES |
| Time off requests must be submitted to your manager at least two weeks in advance.
Please be aware that all time off will be scheduled with staffing needs in mind. You have not received approval for your requested time until you are given a signed copy of this request from your manager. Dates requested: From: To: Total Number of Full Days: Total hours: Total Number of Partial Days: Total hours: Employee Signature: _Date: |
| APPROVAL |
| Approved Not approved
Reason not approved: _____________________________________________________________ Supervisor Signature: Date: |