Request For Time Off
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1REQUEST FOR TIME OFF
EMPLOYEE
REVIEWED BY
NAME
NAME
POSITION
POSITION
DATE SUBMITTED
DATE REVIEWED
DATES REQUESTED OFF
FIRST DAY OFF
RETURN TO WORK
# OF WORK DAYS
TYPE OF REQUEST
Vacation
Appointment (doctor, dentist, etc)
Personal holiday
Bereavement/Funeral leave
Sick time
Leave of absence
FMLA time
Compensated days
Jury duty
Leave without pay
Military leave
Other – Explain:
EMPLOYEE COMMENTS
STATUS OF TIME OFF REQUEST
APPROVED
NOT APPROVED (See reason in comments below)
MODIFIED REQUEST APROVED (See explanation in comments below)
SUPERVISOR COMMENTS
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Parent category: Business