Time Off Request Form
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1
2TIME OFF REQUEST FORM
Turn this request in to the Brothers Cleaning Services office for approval
EMPLOYEE INFORMATION
TODAY’S DATE: ________________________
ACCOUNTS: ___________________________
NAME: _______________________________
POSITION: ______________________
NUMBER OF DAYS REQUESTED: ___________
STARTING ON: _________________________
ENDING ON: __________________________
I WILL RETURN TO WORK ON: _____________________________________________________
TYPE OF REQUEST
VACATION or PERSONAL
SICK (INCLUDING BEREAVEMENT)
JURY DUTY
LEAVE OF ABSENCE
MILITARY LEAVE
These days are to be:
Paid Time Off (If available to use)
Unpaid Time Off
*Paid Time Off must be used before Unpaid Time off allowance is used
EMPLOYEE CERTIFICATION
I understand that time away from work is subject to management approval and company policies.
We would like to grant all requests; however we reserve the right to deny any request in accordance
with business needs.
Time off cannot be taken until your request has been approved AND this form has been returned to you
with an authorized signature AND the“ Approved” box below has been checked.
Make sure you have time-off available. If unsure, call Leanne in the BCS Office.
In order to consider your request, these instructions must be followed, or your request may be denied.
Emergency time-off will be handled on a case by case scenario by management discretion.
ALL LEAVE OF ABSENCE REQUESTS ARE TO BE MADE DIRECTLY TO HUMAN RESOURCES!
EMPLOYEE SIGNATURE: ______________________________________ DATE: _____________
APPROVAL
APPROVED:
YES
NO
REMAINING DAYS AVAILABLE: ______ V
______ S
Supervisor/Manager Approval: _______________________________
Date:______________
Office Manager Comments: ______________________________________________________
_______________________________________________________________________________________________________
Payroll Input: ______________________________________________ Date:______________
Routing: Forward this form to the Office Manager for processing. Return a photocopy to employee once a determination has
been made. Forward original to Office Manager the day after use, confirmation & checked off. OM will forward to HR.
PLEASE SEE OTHER SIDE FOR TIME OFF POLICY
Revised 1.1.16
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Parent category: Business