Form

Full Name:*

Date of Birth:*

Month Day Year

You are entitled to 28 days holiday in any 12-month period.

Your holiday is accrued on a 12 month rolling year based on hours worked.

This form is only a request for a holiday to be taken - it does not automatically grant a holiday.

To qualify for holiday you must give 14 days notice, the holiday must not conflict with other holidays booked with other members of staff working at the same company, no holidays can be taken immediately prior to or immediately after a Bank Holiday, and no more than 2 consectuive weeks at any one time can be taken.

Read the above.*

I have read the above statement

Company working at:*

Department working in:

Line Supervisor:

First Day of Holiday:*

- Day - Month Year

at

/ Hour Minutes

Last Day of Holiday:*

- Day - Month Year

at

/ Hour Minutes

Number of Days you are claiming for:*

Have you notified your Line Supervisor of the holiday you are wishing to take?*

Yes No

Additional Comments: Please also state here whether you are leaving and require all holidays to be paid with your final wage.

TEMP HOLIDAY REQUEST FORM