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Time Off Request
Time Off Request
Name
First
Last
Start Date:
*
MM slash DD slash YYYY
End Date:
*
MM slash DD slash YYYY
Start Time
:
Hours
Minutes
AM
PM
AM/PM
End Time
:
Hours
Minutes
AM
PM
AM/PM
Total Hours
*
Reason for Leave
*
Please indicate the reason for the request. A reason is not required but strongly recommended. The reason for leave will be used to determine approval or denial.
Reason for Leave:
*
Personal Leave
Jury Duty
Funeral Leave
FMLA Leave
Military Leave
Parenting Leave
Other
Relation if Funeral Leave:
HR Signature
To be completed by HR Department. Do not fill in.
Employee Signature
*
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