Select reason for time-off:


Full Name

  • Start Date
  • End Date

  • Number of requested days-off (not including company holidays or weekends).
  • Time-off Details

    During your time-off, will you be accessible via phone & Email during your regular shift hours?


    Terms & Conditions

    • Time off is a request and is subject to approval.
    • Requests should be submitted 2 weeks prior to the "Start Date" of the time-off you entered above.
    • There is a minimum of a half day off per request.
    • Time-off will be reflected on the first pay-period following your time-off.
    • Your time-off must abide by the terms and conditions as listed in the employee handbook.

    You must understand and agree with the terms & conditions listed above to request time off:
    I understand & agree