EmailMe Form - TIME OFF REQUEST FORM

TIME OFF REQUEST FORM

Employee Name *

First Last

Employee Number *

Department *

Department Supervisor *

Type of Absence Requested:

You must submit requests for absences, other than sick leave, 72 hours prior to the first day you will be absent. Please note that if request is submitted afterwards payroll has processed, it will be considered "time off without pay". Form must be filled out COMPLETELY to be considered for approval.

Checkbox *

Sick 05-5220

Vacation 05-5210

Admin Leave 05-5240

Jury Duty 05-5280

*

Holiday 05-5230

Bereavement 05-5240

Time w/o Pay 05-5260

Maternity / Paternity 05-5270

Start DATE: *

MM / DD / YYYY

END Date: *

MM / DD / YYYY

Start TIME: *

HH : MM AM/PM

END Time: *

HH : MM AM/PM

Reason for Absence: *

If using VACATION TIME please list "total" number of hours you wish to use:
(available hours may be obtained from your recent pay stub) *

Total number of Days Requested: *

Total number of Hours Requested: *

Employee Signature *

Clear

Manager Approval: Office Use Only

Approved

Rejected

Comment:

TSRG HR Manager Signature:

Date:

MM / DD / YYYY