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Employee Vacation - Request Form

Today’s Date: ________________________

Employee’s Name: ________________________

Days Requested: _____

Beginning on: ________________________

Ending on: ________________________

Reason for Request


☐ - Vacation ☐ - Personal Leave ☐ - Funeral / Bereavement

☐ - Jury Duty ☐ - Family Reasons ☐ - Medical Leave

☐ - To Vote ☐ - Other: _____________________________________

I understand that this request is subject to approval by Du Ble Pastry


& Bakery Management .

Employee’s Signature: ________________________Date: ___________

Management’s Decision
☐ - Approved

☐ - Rejected

Signature: ________________________Date: ____________

Name: ________________________

Stamp :

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