Request for Day off

I would like to request ______, ______, ______, 20____ Day of Week Month Day Year Off from work.

Circle that which applies:

Day/Half Day Doctor Appt./Personal Time Vacation Day/Other

______Employee Signature Date

Approved/Denied: ______Supervisor Signature Date Comments:______

Paid Time Off______Unpaid Time Off______

Request for Day off

I would like to request ______, ______, ______, 20____ Day of Week Month Day Year Off from work.

Circle that which applies:

Day/Half Day Doctor Appt./Personal Time Vacation Day/Other

______Employee Signature Date

Approved/Denied: ______Supervisor Signature Date Comments:______

Paid Time Off______Unpaid Time Off______