Time Off Request Form

Please submit all Time Off Requests no later than 1 week in advance.

Employee Time Off Request

"*" indicates required fields

Employee Name*

First Last

Email*

Phone Number*

Time off Start Date

Time off Start Time

Time Off End Date

Time off End Time

Did you get approval from your manager for this time off request?*

Yes

If your time off was approved, who approved it?*

Reason for Time Off Request:*

Vacation

Jury Duty

Doctor’s Appointment

Illness

Other

This field is for validation purposes and should be left unchanged.