Request for time off
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This request for time off form collects information about an employee's request including their name, department, type of time off being requested such as paid time off, sick leave, or comp time. It asks for the dates and number of days or hours being requested for each type as well as space for further explanation of the request. The employee signs and dates the form which is then passed to the supervisor for their recommendation on approving, approving with modification, or unapproving the request along with any comments.
Request for time off
- 1. Request for Time Off Name _______________________________________________________________________ Department __________________________________________________________________ REASON DATE(S) # OF DAYS # OF HOURS Paid Time Off _______________ _________ __________ Sick Leave _______________ _________ __________ Comp Time _______________ _________ __________ Annual Military Duty _______________ _________ __________ Jury Duty _______________ _________ __________ Death in Family _______________ _________ __________ (specify relationship below) Other (explain below) _______________ _________ __________ TOTAL TIME OFF: _________ __________ FURTHER EXPLANATION (when required) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Employee signature ______________________________________ Date _______________ SUPERVISOR’S RECOMMENDATION: COMMENTS: Approved: ____________________________________ Approved with following modification: ____________________________________ Unapproved for following reason: ____________________________________ Supervisor’s signature ___________________________________ Date __________________ WHITE COPY: Supervisor YELLOW COPY: Staff Member