• Time Off Request Form

    *NOTE: 1 MONTH NOTICE REQUIRED FOR 2 DAYS OR MORE
    • APPROVERS ONLY 
  •  
  • Date of Approval
     / /
    2 digit month, 2 digit day, 4 digit year
    • Time Off Request 

    • REASON CODES:

      S – SICK (Minimum amount of (2) hour increments)

      B – BEREAVEMENT (Allowed up to (5) working days off upon death of family member)

      J – JURY DUTY (Paid time off for the first day of jury service)

      U – UNPAID (Unpaid time off request, NOT using any SICK hours)

      *Employees must complete a 90-day employment period

    • Start Date*
    • End Date*
    • SIGNATURE 
    • Today's Date:*
       / /
      2 digit month, 2 digit day, 4 digit year
  • Should be Empty: