PM3, 01/14/2020
TOWN OF ROWE
VACATION REQUEST FORM
EMPLOYEE NAME: ____________________________________
DATE OF HIRE: ______________________
I
AM REQUESTING THE FOLLOWING TIME AS VACATION:
FROM: ___________________ TO ___________________
WILL BE RETURNING TO WORK ON:________________________
____________________________________ __________________________
EMPLOYEE SIGNATURE DATE
____________________________________ __________________________
SUPERVISOR SIGNATURE DATE
Office Use Only
Updated in Calendar: _________________
Updated in Vacation Log: _________________
Updated in Employee File: _________________
Vacation Days Allotted: _________________
Vacation Days Used per
Vacation Requests to Date
(including this one): _________________
Vacation Days Available: _________________
click to sign
signature
click to edit
click to sign
signature
click to edit