Helpside Time Off Request Form
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1TIME OFF REQUEST FORM
EMPLOYEE INFORMATION:
Employee Name: ________________________________________
Date: ____________________________
Position: _______________________________________________
Employee ID #: ____________________
Supervisor: _____________________________________________
REQUEST DATES:
__________ /__________ / __________
Time off start date:
__________ / __________ / __________
Time off end date:
__________ / __________ / __________
Return to work:
REQUEST TYPE:
☐
☐
Paid Vacation
Unpaid Vacation
☐
☐
Paid Sick
Unpaid Sick
☐
☐
Paid Personal
Unpaid Personal
☐
Paid Holiday
☐
Unpaid Holiday
☐
Paid Other: ____________________
☐
Unpaid Other: ____________________
ACKNOWLEDGMENT:
Supervisor Approval
☐
Approved
☐
Not Approved
Reason (if not approved) : ________________________________________
Supervisor Signature: ________________________________________
Date: ______________________________
*Employee Signature: ________________________________________
Date: ______________________________
*To be signed by the employee after the supervisor has approved/not approved and discussed this request with the employee.
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Parent category: Business