Time Off Request Form printable pdf download

Time Off Request Form

IME

EQUEST

ORM

Name: ___________________

Date: __/__/__

Dates Requested: From: __/__/__ To: __/__/__

Date of Return to Work: __/__/__

Vacation Time Used? ______ Hrs

Comments

:_______________________________________________

(optional)

______________________________________________________________

__________________________________________________________

Signature: ____________________

(Employee)

General Manager Approval: ___Approved ___Not Approved

Reason

(If Not Approved):_____________________________________________________________

______________________________________________________________________________________

Signature: _______________________ Date: __/__/__

(General Manager)

*All requests must be submitted no later than two weeks before the first requested date.

Revised 4/02/09

Time Off Request Form