Request for Use of Vacation Time or Personal Days
Please complete and submit this form to your Provider/Office Manager. Request Date Employee Name (First and Last Name) Office Title Vacation Time/Personal Time Earned - Please fill in the dates you are requesting off Day you plan to return to the office Employee Signature Date Provider/Office Manager to Fill in Below Approved or Not Approved Total Amount of Days/ Hours Requested by Employee If NOT Approved, Explain Why Provider/Office Manager Date