Employee Time Off Request

A copy of this request and the applicable response will be emailed to your email address supplied below. If a response is not received in a timely manner, the responsibility is upon you to follow-up.


    Your Name:

    Your Email:

    Your Assignment:

    Your Supervisor:

    Start Date (MM/DD/YYYY):

    End Date (MM/DD/YYYY):

    Type of Time Off: (required):

    Explanation/Notes (not required)

    Except for positions with flexible schedules, any PTO requests received with less than ten days notice should be considered “short notice” requests. The employee’s direct supervisor should make a neutral HRN note of any “short notice” requests.