Vacation Request Form

Employee Name*
Employee Number*
Hire Date*
Time Eligible*
Vacation Date:
  MM DD YYYY
/ /
Vacation Date
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Vacation Date
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Vacation Date:
  MM DD YYYY
/ /
Day Off Start Date:
  MM DD YYYY
/ /
Day Off End Date:
  MM DD YYYY
/ /
Please let us know if these are whole days or half days. If half days, indicate Morning or Afternoon.*
Who does your request go to?
    
For Office Use Only
Hours Eligible
Hours Taken
Hours Avail
Hours This Pay
Hours Left
APPROVING MANAGERS SIGNATURE
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