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EMPLOYEE TIME OFF REQUEST FORM

Please submit this form for approval at least four (2) weeks in advance of your preferred vacation dates. All requests should be submitted via email or submitted through the website. Vacation time that is not approved but still taken by the employee will be unpaid and subject to progressive discipline.

Date:

Employee Name:

Vacation Dates Requested: through

Return To Work Date:

Total Number of Days/Hours Requested:

Supervisor Name: Approval or Denial Date:

Approved:

Yes

FOR INTERNAL USE ONLY

Recorded into Employee Calendar:

Yes

Recorded into Payroll System: