Time Off Request Form

Please use this form to request future days off work. If you are asking to be off in the next 48 hours, please call the office and report your absence.

A minimum of two weeks’ notice is required (unless otherwise advised.)

It is your responsibility to confirm the status of the request; do not assume your request has been approved. Requests are granted on a first-come, first served basis. Not all requests can be accommodated.

Employee Name(Required)

First Last

Employee Email(Required)

Employee Phone(Required)

Today’s Date(Required)

Dates requesting off from(Required)

Dates requesting off to(Required)

Return Date(Required)

Use my available Paid Sick Time(Required)

Yes

Do you only need a partial day off?(Required)

Yes

Explain

Agree and submit(Required)

Agree and submit

(By submitting this form, you are agreeing what you have submitted is accurate and true.)

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