AM Media Services Ann Arbor Antiques Market AMC of the Americas Ave Maria Communications Ave Maria Fine Art Gallery Ave Maria Grammar and Prep Inc. Ave Maria Missions Ave Maria School of Law
Ave Maria University Domino's Farms Corp. Domino's Farm Petting Farm Legatus Shepherd Montessori Ctr. The Ave Maria Foundation Thomas More Law Center _____________________
TIME OFF REQUEST FORM
Employee Name ________________________
Vacation Personal /Sick Time Bereavement Leave Jury Duty
Military Leave Family/Medical Leave Act Personal Leave Occupational Injury Other (Explain Below)
Insert beginning and ending dates as well as return date:
______________________ through ______________________, return ____________________
Total Hours Absent:________ Explanation of absence: _________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
Employee Signature _____________________ Supervisor Signature _____________________ (Check One) Instructions: The employee is responsible for completion and submission of this form prior to any absence for use of time off. For occupational injury and sick time, the employee must complete this form immediately upon return to work. Present this form to your supervisor for approval. Distribution: The supervisor should ensure that the time used is recorded on the VSA Report to be submitted to the Ave Maria Human Resources Group/Payroll Department. The supervisor/or designee must retain the original Time Off Request Form in the event of a question or audit.
AMHR:HR12:5/16/2007
Paid
Unpaid