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Time Off Request
Maintaining a record of employee time off requests is important for several reasons. First you want to make sure that requests don't overlap and prevent proper staffing levels. Second you want to ensure you honor requests based on your time off policies established by your company. And third a proper record will make scheduling a snap. Have employee's complete the following form any time they need to request time off.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes

Time Off Request TemplateForm 4195
Format: Word PDF
Category: Employee, Schedule
Type: Request

Time Off Request

Date: ___/___/_____

Please Check One of the Following:

Sick Leave of Absence

Leave Without Pay


Personal Holiday

Vacation Day

Summer Leave Without Pay


Additional Information: __________________________________________________________________________



Employee Name: _______________________________________________________________________________

ID #: _________________________

Total Number of Time Off Days Requested: _________________

Starting Date: ___/___/_____

Return to Work Date: ___/___/_____

Employee Signature: __________________________________________________________ Date: ___/___/_____

Supervisorís Signature: ________________________________________________________ Date: ___/___/_____