Time Off Request Form

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TIME OFF REQUEST
Date:
From:
Time off Request
Subject:
I would like to request the following time off:
Please check the appropriate box:
Sick
Vacation/Personal Day
Unpaid
Jury Duty
Bereavement Leave
Other, ______________________________
List Date(s) Requested:
The total number of Hours/Days I am requesting is: ___
Employee Signature:
_______________________ Date: _____________
Supervisor Signature: _______________________ Date: _____________
Human Resource Signature: __________________ Date: _____________
Time Off Approved:
Time Off Denied:
H:\Human Resource Forms\HR Forms\Time Off Request.doc

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