Time Off Request

Please use a separate form for each time off request.

Requested Start Date*
Requested End Date*

Type of Time Requested Off

Select the type of time requested off in the checkbox, and be sure to enter the numerical value of hours in the corresponding hour box.

Paid Vacation
Paid Sick
Unpaid Time Off

Is this a Leave of Absence? If so, please contact Human Resources.

Date employee will return to work:*

I understand that time away from work is subject to management approval and company policies.