Company Logo
TIME OFF REQUEST FORM
Request #: 2025-001
Date Submitted:
Employee Information
Employee Name
Employee ID
Department
Job Title
Email
Phone
Type of Leave
Vacation / PTO (Paid Time Off)
Sick Leave
Personal Day
FMLA / Parental Leave
Unpaid Leave (LWOP)
Jury Duty / Bereavement
Leave Dates & Type
First Day of Leave
Last Day of Leave
Return to Work Date:
Total Days/Hours:
Coverage & Contact
Reason for Request
...
Covering Person (Backup)-
Emergency Contact Info-
I request leave in accordance with the company Employee Handbook and FMLA guidelines (if applicable).
I certify that this request is valid and I have accrued enough hours.
I certify that this request is valid and I have accrued enough hours.
EMPLOYEE SIGNATURE
Date Approved: ___/___/20__
SUPERVISOR APPROVAL
Signature / Approval
HR / PAYROLL USE ONLY
Record No: _______
* Please submit this form to your supervisor at least 2 weeks in advance for vacation requests.
Company Logo
TIME OFF REQUEST FORM
Request #: 2025-001
Date Submitted:
Employee Information
Employee Name
Employee ID
Department
Job Title
Email
Phone
Type of Leave
Vacation / PTO (Paid Time Off)
Sick Leave
Personal Day
FMLA / Parental Leave
Unpaid Leave (LWOP)
Jury Duty / Bereavement
Leave Dates & Type
First Day of Leave
Last Day of Leave
Return to Work Date:
Total Days/Hours:
Coverage & Contact
Reason for Request
...
Covering Person (Backup)-
Emergency Contact Info-
I request leave in accordance with the company Employee Handbook and FMLA guidelines (if applicable).
I certify that this request is valid and I have accrued enough hours.
I certify that this request is valid and I have accrued enough hours.
EMPLOYEE SIGNATURE
Date Approved: ___/___/20__
SUPERVISOR APPROVAL
Signature / Approval
HR / PAYROLL USE ONLY
Record No: _______
* Please submit this form to your supervisor at least 2 weeks in advance for vacation requests.