Time Off Request Form
Today's Date:
-
Month
-
Day
Year
Employee Name:
*
Allen Carmichael
Andrea Ralston
Angela Evans
Caitlin Rocket
Cal Winn
Dave Kirby
Devin Edgley
Fran Zankowski
George Hardwick
Joel Dyer
Julian Bourke
Kellie Robinson
Mark Goodman
Olivia Rolf
Sue France
Email Address:
*
Start Date:
*
-
Month
-
Day
Year
at
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
End Date:
*
-
Month
-
Day
Year
at
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
Total Hours:
*
PAID or UNPAID:
*
Paid
Unpaid
Not Sure
Comments:
Submit
Should be Empty: