TIME OFF REQUEST FORM
TO BE COMPLETED BY EMPLOYEE:
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Date: _____________________
Employee’s Name: _______________________________
Department/Title: _______________________________
Time off Request: ______ ☐Days ☐Hours
Beginning on: ____________________________
Ending on: _____________________________
Reason for Request
☐Paid time off ☐Compassionate leave
☐Sick Leave ☐Home Office
☐Unpaid time off ☐Maternity Leave
☐Vacation ☐Time off in lieu
☐Other ________________________________________________
Date: ______________________________
Employee’s signature: ______________________________
TO BE COMPLETED BY EMPLOYER:
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Employer’s Decision
☐Approved ☐Rejected
Date: ______________________________
Employer’s signature: ______________________________
