Vacation Request
Date: ___/___/_____
Employee Name: _______________________________________________________________________________
Department: ___________________________________________________________________________________
Supervisor’s Name: _____________________________________________________________________________
Hire Date: ___/___/_____
Vacation Earned:
[___] Employed One Year…Results in one week (five work days) of paid vacation.
[___] Employed Two Years…Results in two weeks (ten work days) of paid vacation.
[___] Employed Three or more years…Results in three weeks (fifteen work days) of paid vacation.
Dates of Vacation: ___/___/_____ to ___/___/_____
Previous number of days taken: _________________
Number of days for this request: ________________
Balance of vacation remaining: __________________
Employee’s Signature: _________________________________________________________ Date: ___/___/_____
Supervisor’s Signature: ________________________________________________________ Date: ___/___/_____
Manager’s Approval:
[___] Approved
[___] Rejected
Notes: ________________________________________________________________________________________
_____________________________________________________________________________________________
Manager’s Signature: __________________________________________________________ Date: ___/___/_____
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