Time Off Request -AndrewTime Off Request-Andrew Employee * Email * Date Position * TYPE OF REQUEST Vacation Sick Personal Time Off Other Late Leave Early Paid (If Available) UNPAIDTime of Arrival 121234567891011 : 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 AMPMTime of Departure 121234567891011 : 000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 AMPMREASON FOR TIME OFF REQUIRED FIELD – PROVIDE A BRIEF DESCRIPTION DETAILING THE REASON FOR TIME OFF * DATES REQUESTED Do Not combine time off requests between pay periods(28th-12th & 13th-27th) Time off requests should be taken in one hour increments. Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours Date Hours TOTAL DAYS * TOTAL HOURS * EMPLOYEE SIGNATURE Signature * Clear Date * MANAGER APPROVAL SECTION | DO NOT USE Supervisor Signature Clear Date Approved Approved with Modification Not Approved Comments Page 1 of 1HR-4444-F Time Off Request Form Submit