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TIME OFF REQUEST FORM - DOC

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					                                               [COMPANY]

                                      Time off Request Form
This form must be completed and submitted to your Supervisor at least 2 weeks prior to your
requested time off start date. If submitted any later, it is not as likely to be approved.

Employee Name                                      Dept. Supervisor

Time off Start Date                                Return to Work Date

 Total Time Off
 Please check only 1 of the           Hours (Enter totals hours)
 boxes and fill in the total
 shifts and/or hours that you         Full Day (If taking 1 or more regularly-scheduled days off)
 will be taking off.
                                      Full Day +       Hours (If taking Full Day and Partial Days off)

 Days & Hours Off                   Date               Day                Time Off               Time Off
 Please list the dates, days,    (MM/DD/YY)        (e.g. Monday)            Start                  End
 and times that you would                                                             AM                    AM
 like to take off.                                                                    PM                    PM
                                                                                      AM                    AM
                                                                                      PM                    PM
                                                                                      AM                    AM
                                                                                      PM                    PM
                                                                                      AM                    AM
                                                                                      PM                    PM
                                                                                      AM                    AM
                                                                                      PM                    PM
                                                                                      AM                    AM
                                                                                      PM                    PM
                                                                                      AM                    AM
                                                                                      PM                    PM
 Type of Leave                    Personal Leave       Sick Leave         Other Without Pay - describe
                                 (With Pay)                               in Reason For Leave box.

Reason for Leave

I understand that I am not guaranteed to get the day(s) off that I have requested. I also understand
that the approval or disapproval of my request will be based on the needs of the company and
whether or not the shift(s) can be covered.



Employee Signature                                                                     Date

Approvals:                      Request Approved             Request Denied             See Scheduling

Reason for Denying Request




Supervisor Signature                                                                   Date

				
DOCUMENT INFO
Description: As a worker, your employees occasionally need time off for certain reasons. With this form, your employees can submit requests for time off to their supervisor early, so the manager can ensure coverage over the employee’s shift