HR- Employee / Contractor Time Off Request Form

Today's Date*

Employee Name*

First Last

Date Requested (1st day off)*

Date Returning to Work*

Other Info Needed:

Do you have an alternate choice of dates if needed?*

Alternate start date*

Alternate return date*

Have you asked someone to cover your shift?*

Is that person available?*

Who is the employee willing to take the shift?*

I am requesting to use hours from*

This request is for

We are incredibly sorry for your loss. What is your relationship with the recently deceased?*

Explain the reason for time off:*

How many hours in total paid time-off are you requesting (if any)?*

Do you think there is a possibility that the time-off requested may extend beyond the time/day requesting?

We ask this question so we know if we should reach out to another team member to potentially have him/her available to cover your shift if necessary.