TIME OFF REQUEST FORM

Guidelines: Employee should notify their Department Manager with the following notice in
advance of anticipated time off.

DURATION OF TIME OFF NOTICE

2 days or less 1 week
3 to 5 days 4 weeks
More than 5 days 6 weeks

Employee Name: Sukrit Ghorai Date Submitted: 07/22/2018

Date(s) Requested: 07/05/2018, 07/06/2018

Comments: (optional)
Out of Town

Employee Signature:

Approved Denied

Supervisor Signature: Date:

Comments: (optional)

PROCEDURES AFTER REQUEST IS APPROVED

Employee: List dates on your Outlook Calendar
Copy to Human Resources for Personnel File

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