Time Off Request Form

* You must submit requests for absences, other than sick leave or an emergency. Two weeks prior to the first day you will be absent. Requests for extended absences (1+ days) require submittal 30 days prior to the first day you will be absent.

Please note: all time off requests will not be granted. Please contact Robert if you have any questions or concerns.

Time Off Requests

Today's Date*
MM slash DD slash YYYY
Name*
First Last
Manager's Name*

(Eddie, Alvaro, or Jose)
Phone*
Your Phone Number Goes Here
Email*

Your Email Goes Here
Date You Are Leaving*
MM slash DD slash YYYY
Date You Are Returning*
MM slash DD slash YYYY
Number Of Work Days You Will Be Absent*
Select All That Apply*
- Personal Time Off
- Sick / Illness
- Vacation
- Military
- Jury Duty
- Bereavement
- Maternity/Paternity
- Time Off Without Pay
- Other
Reason For Time Off*