Forms • Time Off Request Form

Time Off Request Form

Leave This Blank:

REQUEST FOR VACATION SICK DAYS OR RUNNING LATE FORM If requesting a Half Day put the date a space and .5 If you do not put the .5 a full day will be charged. Put a comma in-between each date requested if you are requesting multiple days.
(If you are employed at DPW, Please use DPW Form link below to go to that form) DPW Form
FIRST & LAST NAME*
Leave Requested
Dates Requested for Vacation Leave
Date Requested for Personal Day/s
Dates Requested for Sick Leave
If Running Late Please give the reason & How long you anticipate to be late to work
If Other is a choice please give date/s needed and explain:
Approval is granted based on the assumption that an employee still has the requested time available. Approval may be withdrawn if sufficient coverage is not available within a department.
You may submit this form for multiple days Vacation Requests, Personal Days

* indicates required fields.