Employee Time Off Request Form

April 17, 2012

Use this form to document an employee’s request for time off from the medical practice.

To download this form, click here: Time Off Request Form.doc


 

EMPLOYEE TIME-OFF REQUEST FORM

Date: _____________

Employee’s Name: ___________________________________________________

Time Off Requested: __________________________________________________

Reason for Time Off: __________________________________________________

Comments: ________________________________________________________

Employee’s Signature: _________________________________________________

 Time off granted as vacation leave.
 Time off granted as sick leave.
 Time off granted without pay.
 Time off granted with pay.
 Time off not granted.

Signature: ____________________________________________________

Date: _____________


To download this form, click here: Time Off Request Form

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