Time Off Request Form

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TIME OFF REQUEST FORM
EMPLOYEE INFORMATION
NAME:__________________________________________
POSITION:____________________
q
q
NUMBER OF WORK DAYS REQUESTED____________
Paid
Unpaid
STARTING ON:__________________________
TO:
_____________________________
I WILL RETURN TO WORK ON:_______________________________
q
q
LOCATION:
PORT ST. LUCIE EAST
PALM BEACH GARDENS
q
q
PORT ST. LUCIE WEST
BOYNTON/DELRAY
q
q
JUPITER
AVENTURA
TYPE OF REQUEST
q
q
VACATION
FAMILY & MEDICAL LEAVE
q
q
SICK TIME
JURY DUTY
q
q
PERSONAL LEAVE
TIME OFF TO VOTE
COMMENTS
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
EMPLOYEE CERTIFICATION
q
I UNDERSTAND THAT TIME AWAY FROM WORK IS SUBJECT TO MANAGEMENT
APPROVAL AND COMPANY POLICIES
EMPLOYEE NAME:_______________________________
DATE:_________________
APPROVAL
q
APPROVED
q
REJECTED
SUPERVISOR/MANAGER APPROVAL:___________________________
DATE:___________________

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