Fillable Employee Time-Off Request Form

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Employee Time-Off Request Form

On average this form takes 6 minutes to complete

The Employee Time-Off Request Form form is 1 page long and contains:

  • 2 signatures
  • 12 check-boxes
  • 9 other fields

Country of origin: OTHERS
File type: PDF

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Employee Time-Off Request Form
Today’s Date: ________________________
Employee’s Name: ________________________
Time-Off Request: _____ ☐ Days ☐ Hours
Beginning on: ________________________
Ending on: ________________________
Reason for Request
☐ - Vacation ☐ - Personal Leave ☐ - Funeral / Bereavement
☐ - Jury Duty ☐ - Family Reasons ☐ - Medical Leave
☐ - To Vote ☐ - Other: _____________________________________
I understand that this request is subject to approval by my employer.
Employee’s Signature: ________________________ Date: ___________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Employer’s Decision
☐ - Approved ☐ - Rejected
Employer’s Signature: ________________________ Date: ____________
Print Name: ________________________
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Employee Time-Off Request Form

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Completed 15 April 2021

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