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TIME OFF REQUEST

*** Please discuss & confirm coverage with your fellow employees prior to making request***

Multiple Days:______________________ thru ______________________ Total


Hours:______

Single Day:_________________________ Total Hours:____________

Partial Day:_______________________ Total Hours:______________

 Partial Days: Please list the time you will be out

From (time)________________ to ___________________________

Coverage Needed? Yes No Description of Coverage Needed__________________________

Coverage Plan: ________________will cover Other______________________________

Signature/Agreement of Person Covering:________________________________________________

Employee Signature: ______________________________ Date Requested: _______________________

Approved By: ___________________________________ Date Approved: _______________________


White>>> payroll file Yellow>>> employee Pink>>> person covering Vacation Calendar

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