Employee Time Off Request
Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Configurable list
*
Time Period Requesting Off (i.e., 9:30-11 am)
*
Is a Substitute Needed?
*
Yes
No
Sub Needed for Partial Day Only
If Sub Needed for Partial Day, List Hrs & Classes Here
Employee Signature
*
Submit
For Director Use Only:
Time Off Is:
Approved
Denied
PTO to be deducted (for FT Salaried Employees)
Sub Name
Sub Notes
Should be Empty: