Time Off Request

All time off request should be submitting using this sheet below. Please fill in each blank so appointed manager may review and respond in a time efficient manner.

Advance Notice Requirements

•1 day off: At least 1 week advance notice

•2-10 days off: At least 3 weeks advance notice

•More than 10 consecutive days: At least 6 weeks advance notice

•Emergency/illness: Notify supervisor as soon as possible, preferably before scheduled work time

Name

First Name

Last Name

Job Title

Phone

(###)

###

####

Start Date

Add the first date you will need off

YYYY

End Date

Add the end date you will need off

YYYY

Reason

Reason for Request

Will you be using PTO allowance time?

This is only if you know you have PTO time available to use. Please refer to your paystub.

I understand this request is subject to approval by my employer.

I understand

Time Off Request

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