Time Off In Lieu Request Form
Submit your request for time off in lieu of extra hours worked.
Employee Full Name
*
First Name
Last Name
Employee ID
*
Department
*
Please Select
Human Resources
Finance
IT
Sales
Marketing
Operations
Other
Work Email Address
*
example@example.com
Date(s) Extra Hours Worked
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Total Number of Extra Hours Worked
*
Reason for Extra Hours Worked
*
Requested Date(s) for Time Off in Lieu
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Requesting Time Off in Lieu
*
Manager/Supervisor Name
*
First Name
Last Name
Manager/Supervisor Email
*
example@example.com
Attach Supporting Documents (if any)
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of
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