Vacation Request Form

Vacation:

Yes

No

Leave w/o pay:

Yes

No

To be reviewed by:

Name

First Name

Last Name

Date gone:

MM

DD

YYYY

Date of return:

MM

DD

YYYY

Hours available for the year:

Comments:

Office section only:

Reviewed signatures:

Date:

MM

DD

YYYY

Reviewed Signatures:

Date:

MM

DD

YYYY

Please circulate to all reviewers & last signature person return to accounting. Thank you.