Time Off Request Form

Create Document

Time Off Request Form

A time off request form provides a standardized method for employees to ask for time away from work. Employers can use the document to evaluate each request fairly, noting the dates and reasons for the absence. This aids management in making an informed decision to approve or deny the time off.

Create Document
Fill Now
Download
Word
ODT

Last updated July 11th, 2025

Document Preview

A time off request form provides a standardized method for employees to ask for time away from work. Employers can use the document to evaluate each request fairly, noting the dates and reasons for the absence. This aids management in making an informed decision to approve or deny the time off.

Downloads: 3
  1. Home »
  2. Employee Forms »
  3. Time Off Request Form

Time Off Mandates

There are no federal laws regarding the amount of paid or unpaid time off an employee must get. However, the Family and Medical Leave Act (FMLA) states that employees working for a covered employer can take twelve unpaid weeks off in twelve months and have their jobs secure.[1] The reasons covered are:
  • The employee has a significant health problem
  • The birth of a baby or their care
  • Foster care or adoption placement
  • The employee’s parent, spouse, or child has a serious medical issue
  • The employee has urgent requirements related to the military deployment of a family member.

Sample

PDF, MS Word, ODT

[EMPLOYER NAME]
TIME OFF REQUEST
EMPLOYEE INFORMATION

Employee Name: [EMPLOYEE NAME]

Department and position: [EMPLOYEE DEPARTMENT AND POSITION]

Total days off: [TOTAL # DAYS OFF]

Total hours off: [TOTAL # HOURS OFF]

Beginning on: [MM/DD/YYYY]

Ending on: [MM/DD/YYYY]

Type of leave:

☐ – Vacation
☐ – Personal leave
☐ – Sick leave
☐ – Medical leave
☐ – Family leave
☐ – Funeral/bereavement
☐ – Jury duty
☐ – Other: [REASON FOR TIME OFF]

Employee Comments: [ADDITIONAL COMMENTS]

I understand that this request is subject to approval by my employer.

Employee Signature: _____________________________ Date: ____________

MANAGER INFORMATION

Manager Name: [MANAGER NAME]

☐ – Time off approved
☐ – Time off denied

Manager comments [MANAGER ADDITIONAL COMMENTS]

Manager Signature: _____________________________ Date: _____________

Sources

  1. U.S. Dept. of Labor – Family and Medical Leave Act