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Employee Time-Off Request Form

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The Employee Time-Off Request Form is meant to be filled out by an Employee who requires permission to be absent from work. This form will gather information regarding the Time Off that is being requested, why it is being requested, and when the Employee expects to return to work. Employees using this form should be aware that, in nearly all cases, clear approval from one’s place of employment must be gained in order to stray from the work schedule they agreed to. Permission may be granted through the Approval section below.

How To Write

Step 1 – Choose the PDF button, ODT button, or Word button below the image on the right to download a copy of the Employee Time-Off Request Form of any of the three file types named.

Step 2 – The first item requiring attention on this form is the “Employee Information” section at the top of this page. On the first row, enter your Full Name. Next, enter the current date on the second row. On the third row, report the total Number of Days Off you would like to have.

Step 3 – Locate the words “Starting On,” then report the Date you would like your first day off to be. Next to this, in the state labeled “Ending On,” report the Date of the last day off you intend on having. Below this on the blank line labeled “I will Return to Work On,” report the exact Date you will return to work.

Step 4 – In the next section, “Type of Request,” indicate the reason you are requesting this time off. There will be several blank lines, each with a common reason listed, to choose from. You may only select one of these choices: Vacation, Personal Leave, Funeral/Bereavement Leave, Jury Duty, Family and Medical Leave, Late, Other, or Time Off to Vote. If you select Other, you should specify why you want the time off in the section, labeled “Comments,” after this one.

Step 5 – The next area, “Comments,” will contain several lines to allow you to neatly add any additional comments or reasons. For instance, if you reported “Other” in the previous section, you may wish to expand on that in this section.

Step 6 – Locate the words “Employee Signature” in the “Employee Certification” section, then Sign your Name on the blank line provided. On the blank space labeled “Date,” report the Date you are signing this document.

Step 7 – The final area, below the word “Approval,” must be filled out by the Supervisor or Manager approving the Time Off you are requesting. Do not fill in any of the information required here. The Supervisor or Manager will mark either the “Yes” or the “No” line to indicate his or her response to this request. Below this, the Signature of the Supervisor/Manager must be presented along with the Date this decision was made. The last line should contain the Printed Name of the Manager/Supervisor along with his or her Title. Review this area when you receive the returned document.

Step 8 – Your employer should have provided you with a method to submit such a form when requesting time off. In many cases, you will be able to submit this form directly to your Supervisor or the Human Resources Department of that Company.

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