2023 Sick/Vacation Form

Employee Name (Print): ____________________________________

Supervisor Name: (Print): ___________________________________

Circle one: Sick OR Vacation

*The vacation request must be submitted at least two weeks prior to the time off being requested.

Vacation/Sick Starting: (First Ending: (Last

Requested For: Day out of Day out of
Office) Office)

Employee’s Signature:

________________________________________________

Supervisor’s Signature:

________________________________________________

HR Manager To Complete:
Emp Vacation Available Time: _____________

Emp Hire Date: _____________