Student Employee Time Off Request Form
STUDENT EMPLOYEE TIME OFF REQUEST FORM
Your request for time off must be submitted and approved by management in advance.
EMPLOYEE INFORMATION
NAME:
TODAY’S DATE:
NUMBER OF DAYS REQUESTED:
STARTING ON:
ENDING ON:
I WILL RETURN TO WORK ON:
TYPE OF REQUEST
VACATION
PERSONAL LEAVE
FUNERAL/BEREAVEMENT LEAVE
JURY DUTY
LATE
FAMILY AND MEDICAL LEAVE
TIME OFF TO VOTE
OTHER
COMMENTS
EMPLOYEE CERTIFICATION
I understand that time away from work is subject to management approval and company
policies.
Employee Signature: Date:
APPROVAL
APPROVED: YES NO
Supervisor/Manager Approval: Date:
Printed Name: Title:
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