Time Off Request Date* MM slash DD slash YYYY Employee First & Last Name* Phone*I would like to request time off for the following datesTime Off Start Date* MM slash DD slash YYYY I will return to work on* MM slash DD slash YYYY I understand that this is not guaranteed time off, I may have to come in on a day off and my prior attendance is taken into consideration. Form must be 100% filled out correctly. It is just that, a request.Type of Request*-- SELECT ONE --VacationPersonal LeaveFuneral / Bereavement LEaveJury DutyFamily and Medical LeaveTime off to voteOtherCommentsI understand that time away from work is subject to management approval and company policiesEmployee Signature*
