Time-off Request Form

Date: Select date.
Employee Name: Enter name. Associate #: Enter number.
Leave used: ☐ CPT
☐ SIC
☐ VAC
Date(s) requested: Enter date(s).
Remarks: Click here to enter text.
*Forward to roster manager*
Roster Manager Section
☐ Approved
☐ Denied
☐ If denied, check reason:
☐ Staffing shortage
☐ Insufficient leave balance
☐ Seniority given preference
☐ Schedule is posted
☐ Other: Click here to enter text.
Supervisor: Enter name.