Time Off Request Form

Question Title

* 1. Employee Name:

First name

Last name

Question Title

* 2. Employee Phone Number:

Country Code

Phone number

Question Title

* 3. Employee Email:

Email address

Question Title

* 4. Manager Name:

First name

Last name

Question Title

* 5. Manager Phone Number:

Country Code

Phone number

Question Title

* 6. Manager Email:

Email address

Question Title

* 7. Department:

Question Title

* 8. Date of Request:

Date / Time

Date

Question Title

* 9. Requested leave start date:

Date / Time

Date

Question Title

* 10. Requested return date:

Date / Time

Date

Question Title

* 11. Type of leave requested:

Vacation leave

Sick leave

Bereavement leave

Jury duty

Parental leave

FMLA leave

Leave without pay

Question Title

* 12. Type of leave explanation: